待翻译

Many kids (and parents) who have seen Luke Skywalker battle Darth Vader with a light saber think lasers are cool.

What they may not know is this: When operated unsafely, or without certain controls, the highly-concentrated light from lasers—even those in toys—can be dangerous, causing serious eye injuries and even blindness. And not just to the person using a laser, but to anyone within range of the laser beam.

The U.S. Food and Drug Administration is concerned about this potential danger to children and those around them and in 2014 issued a guidance document (PDF 60K) on the safety of children’s toy laser products.

“A beam shone directly into a person’s eye can injure it in an instant, especially if the laser is a powerful one,” explains Dan Hewett, health promotion officer at the FDA’s Center for Devices and Radiological Health.

Moreover, eye injuries caused by laser light usually don't hurt. Vision can deteriorate slowly and, therefore, may go unnoticed, for days and even weeks. Ultimately, the damage could be permanent, Hewett says.

Some examples of laser toys are:
lasers mounted on toy guns that can be used for “aiming”;spinning tops that project laser beams while they spin;hand-held lasers used during play as “light sabers”; andlasers intended for entertainment that create optical effects in an open room.

The FDA Regulates Lasers
A laser creates a powerful, targeted beam of electromagnetic radiation that is used in many products, from music players and printers to eye-surgery tools. The FDA regulates radiation-emitting electronic products, such as lasers (including children’s toy laser products), and sets radiation-safety standards that manufacturers must meet.

Toys with lasers are of particular interest to the FDA because children can be injured by these products. Because they are marketed as toys, parents and kids alike may believe they’re safe to use.

For toys to be considered minimal risk, the FDA recommends that the levels of radiation and light not exceed the limits for Class 1, the lowest level in regulated products as defined by the International Electrotechnical Commission (IEC).

Lasers used for industrial and other purposes often need higher radiation levels for their intended functions. But these higher levels are not needed for children’s toys—and if they are present, they can be dangerous.

Hand-held laser pointers—often used in business and higher education to help illustrate presentations—have increased in power 10-fold or more over the last decade. And while adults may buy a laser pointer for use in work, kids often play with them for amusement.

The fact that lasers can be dangerous may not be evident, particularly to the children who inappropriately use them as toys, or to the adults who supervise them.

Laser Safety: Tips to Keep in Mind
Remember that laser products are generally safe when they follow the legal limits and are used as directed. But lasers can cause harm if not used properly. The FDA recommends the following general safety tips for consumers.

Never aim or shine a laser directly at anyone, including animals. The light energy from a laser aimed into the eye can be hazardous, perhaps even more than staring directly into the sun.
Do not aim a laser at any vehicle, aircraft, or shiny surface. Remember that the startling effect of a bright beam of light can cause serious accidents when aimed at a driver in a car, for instance, or otherwise negatively affect someone doing another activity (such as playing sports).
Look for an FDA-recommended IEC Class I label on children’s toy lasers. The label says “Class 1 Laser Product,” which would clearly communicate that the product is of low risk and not in a higher emission level laser class.
Do not buy laser pointers for children, or allow children to use them. These products are not toys.
Do not buy or use any laser that emits more than 5mW power, or that does not have the power printed on the labeling.
Immediately consult a health care professional if you or a child suspects or experiences any eye injury.

You can watch the FDA’s video on laser pointer safety [disclaimer icon] for more information.

Many kids (and parents) who have seen Luke Skywalker battle Darth Vader with a light saber think lasers are cool.

What they may not know is this: When operated unsafely, or without certain controls, the highly-concentrated light from lasers—even those in toys—can be dangerous, causing serious eye injuries and even blindness. And not just to the person using a laser, but to anyone within range of the laser beam.

The U.S. Food and Drug Administration is concerned about this potential danger to children and those around them and in 2014 issued a guidance document (PDF 60K) on the safety of children’s toy laser products.

“A beam shone directly into a person’s eye can injure it in an instant, especially if the laser is a powerful one,” explains Dan Hewett, health promotion officer at the FDA’s Center for Devices and Radiological Health.

Moreover, eye injuries caused by laser light usually don't hurt. Vision can deteriorate slowly and, therefore, may go unnoticed, for days and even weeks. Ultimately, the damage could be permanent, Hewett says.

Some examples of laser toys are:

lasers mounted on toy guns that can be used for “aiming”;

spinning tops that project laser beams while they spin;

hand-held lasers used during play as “light sabers”; and

lasers intended for entertainment that create optical effects in an open room.

The FDA Regulates Lasers
A laser creates a powerful, targeted beam of electromagnetic radiation that is used in many products, from music players and printers to eye-surgery tools. The FDA regulates radiation-emitting electronic products, such as lasers (including children’s toy laser products), and sets radiation-safety standards that manufacturers must meet.

Toys with lasers are of particular interest to the FDA because children can be injured by these products. Because they are marketed as toys, parents and kids alike may believe they’re safe to use.

For toys to be considered minimal risk, the FDA recommends that the levels of radiation and light not exceed the limits for Class 1, the lowest level in regulated products as defined by the International Electrotechnical Commission (IEC).

Lasers used for industrial and other purposes often need higher radiation levels for their intended functions. But these higher levels are not needed for children’s toys—and if they are present, they can be dangerous.

Hand-held laser pointers—often used in business and higher education to help illustrate presentations—have increased in power 10-fold or more over the last decade. And while adults may buy a laser pointer for use in work, kids often play with them for amusement.

The fact that lasers can be dangerous may not be evident, particularly to the children who inappropriately use them as toys, or to the adults who supervise them.

Laser Safety: Tips to Keep in Mind
Remember that laser products are generally safe when they follow the legal limits and are used as directed. But lasers can cause harm if not used properly. The FDA recommends the following general safety tips for consumers.

Never aim or shine a laser directly at anyone, including animals. The light energy from a laser aimed into the eye can be hazardous, perhaps even more than staring directly into the sun.
Do not aim a laser at any vehicle, aircraft, or shiny surface. Remember that the startling effect of a bright beam of light can cause serious accidents when aimed at a driver in a car, for instance, or otherwise negatively affect someone doing another activity (such as playing sports).
Look for an FDA-recommended IEC Class I label on children’s toy lasers. The label says “Class 1 Laser Product,” which would clearly communicate that the product is of low risk and not in a higher emission level laser class.
Do not buy laser pointers for children, or allow children to use them. These products are not toys.
Do not buy or use any laser that emits more than 5mW power, or that does not have the power printed on the labeling.
Immediately consult a health care professional if you or a child suspects or experiences any eye injury.

You can watch the FDA’s video on laser pointer safety [disclaimer icon] for more information.

Most people have had an X-ray taken at some time during their lives — perhaps checking for a possible broken bone or during a visit to the dentist. X-ray exams provide important information to physicians about how to treat their patients. However, X-rays use ionizing radiation, and these imaging exams must be carefully and judiciously used on pediatric patients.

While the level of risk from the radiation associated with X-rays is small, especially when compared with the benefits of an accurate diagnosis, health care professionals must be especially sensitive to their appropriate use in children. Pediatric patients generally require less radiation than adults to obtain a quality image from an X-ray exam, so doctors must take extra care to “child size” the radiation dose.

FDA's Role

The FDA's Center for Devices and Radiological Health (CDRH) regulates medical imaging devices. Among its responsibilities is keeping consumers and health care professionals informed about the importance of minimizing unnecessary radiation exposure during medical procedures.

The level of ionizing radiation from X-ray imaging is generally very low, but can contribute to an increased risk of cancer. Because children have longer expected lifetimes ahead of them for potential effects to appear and the risk for cancer is not fully understood, it’s important to use the lowest radiation dose necessary to provide a diagnostic exam.

The FDA is committed to protecting the health of children by providing guidance to manufacturers and users of imaging devices to help lower the exposure to radiation from X-ray exams. The FDA has regulatory oversight of X-ray imaging devices and the companies that make them. To better address radiation safety concerns, the FDA has been encouraging both equipment improvements and better user information.

The FDA also promotes the adoption of improved radiation safety guidelines by professional organizations for both facilities and personnel.

Recommendations

In a new guidance FDA recommends that medical X-ray imaging exams be optimized to use the lowest radiation dose needed. These exams, which include computed tomography (CT), fluoroscopy, dental, and conventional X-rays, should be performed on children and younger patients only when the health care provider believes they are necessary to answer a clinical question or to guide treatment.

The FDA defines the pediatric population as birth through 21 years old. However, the optimization of image quality and radiation dose in X-ray imaging depends more on a patient’s size than their age. Smaller patients require less radiation to obtain a medically useful image. Technically, the patient’s body thickness (the distance an X-ray travels through the body to create the image) is the most important consideration when “child-sizing” an image protocol.

Unnecessary radiation exposure during medical procedures should be avoided. However, X-rays and CT scans should never be withheld from a child or adult who has a medical condition where the exam could provide important health care information that may aid in the diagnosis or treatment of a serious or even life-threatening illness.

What Parents Can Do

The FDA encourages parents and caregivers to talk to their child’s health care provider about X-rays and suggests:
Keeping track of their child's medical-imaging historiesAsking the referring physician about the benefits and risks of imaging procedures, such as: How will the exam improve my child's health care Are there alternative exams to X-rays that are equally usefulAsking the imaging facility: How does the facility use reduced radiation techniques for children Is there any advanced preparation necessary Report any adverse events to the FDA.

The Role of Health Care Professionals

Health care professionals are responsible for ensuring there is justification for all X-ray imaging exams performed on pediatric patients. They should also consider whether another type of imaging exam that does not expose the patient to ionizing radiation, such as ultrasound or magnetic resonance imaging, could be used to obtain the same result.

Most people have had an X-ray taken at some time during their lives — perhaps checking for a possible broken bone or during a visit to the dentist. X-ray exams provide important information to physicians about how to treat their patients. However, X-rays use ionizing radiation, and these imaging exams must be carefully and judiciously used on pediatric patients.

While the level of risk from the radiation associated with X-rays is small, especially when compared with the benefits of an accurate diagnosis, health care professionals must be especially sensitive to their appropriate use in children. Pediatric patients generally require less radiation than adults to obtain a quality image from an X-ray exam, so doctors must take extra care to “child size” the radiation dose.

FDA's Role

The FDA's Center for Devices and Radiological Health (CDRH) regulates medical imaging devices. Among its responsibilities is keeping consumers and health care professionals informed about the importance of minimizing unnecessary radiation exposure during medical procedures.

The level of ionizing radiation from X-ray imaging is generally very low, but can contribute to an increased risk of cancer. Because children have longer expected lifetimes ahead of them for potential effects to appear and the risk for cancer is not fully understood, it’s important to use the lowest radiation dose necessary to provide a diagnostic exam.

The FDA is committed to protecting the health of children by providing guidance to manufacturers and users of imaging devices to help lower the exposure to radiation from X-ray exams. The FDA has regulatory oversight of X-ray imaging devices and the companies that make them. To better address radiation safety concerns, the FDA has been encouraging both equipment improvements and better user information.

The FDA also promotes the adoption of improved radiation safety guidelines by professional organizations for both facilities and personnel.

Recommendations

In a new guidance FDA recommends that medical X-ray imaging exams be optimized to use the lowest radiation dose needed. These exams, which include computed tomography (CT), fluoroscopy, dental, and conventional X-rays, should be performed on children and younger patients only when the health care provider believes they are necessary to answer a clinical question or to guide treatment.

The FDA defines the pediatric population as birth through 21 years old. However, the optimization of image quality and radiation dose in X-ray imaging depends more on a patient’s size than their age. Smaller patients require less radiation to obtain a medically useful image. Technically, the patient’s body thickness (the distance an X-ray travels through the body to create the image) is the most important consideration when “child-sizing” an image protocol.

Unnecessary radiation exposure during medical procedures should be avoided. However, X-rays and CT scans should never be withheld from a child or adult who has a medical condition where the exam could provide important health care information that may aid in the diagnosis or treatment of a serious or even life-threatening illness.

What Parents Can Do

The FDA encourages parents and caregivers to talk to their child’s health care provider about X-rays and suggests:

Keeping track of their child's medical-imaging histories

Asking the referring physician about the benefits and risks of imaging procedures, such as: How will the exam improve my child's health care Are there alternative exams to X-rays that are equally useful

Asking the imaging facility: How does the facility use reduced radiation techniques for children Is there any advanced preparation necessary Report any adverse events to the FDA.

The Role of Health Care Professionals

Health care professionals are responsible for ensuring there is justification for all X-ray imaging exams performed on pediatric patients. They should also consider whether another type of imaging exam that does not expose the patient to ionizing radiation, such as ultrasound or magnetic resonance imaging, could be used to obtain the same result.

Dietary supplementation is approximately a $30 billion industry in the United States, with more than 90 000 products on the market. In recent national surveys, 52% of US adults reported use of at least 1 supplement product, and 10% reported use of at least 4 such products.1 Vitamins and minerals are among the most popular supplements and are taken by 48% and 39% of adults, respectively, typically to maintain health and prevent disease.

Despite this enthusiasm, most randomized clinical trials of vitamin and mineral supplements have not demonstrated clear benefits for primary or secondary prevention of chronic diseases not related to nutritional deficiency. Indeed, some trials suggest that micronutrient supplementation in amounts that exceed the recommended dietary allowance (RDA)—eg, high doses of beta carotene, folic acid, vitamin E, or selenium—may have harmful effects, including increased mortality, cancer, and hemorrhagic stroke.

In this Viewpoint, we provide information to help clinicians address frequently asked questions about micronutrient supplements from patients, as well as promote appropriate use and curb inappropriate use of such supplements among generally healthy individuals. Importantly, clinicians should counsel their patients that such supplementation is not a substitute for a healthful and balanced diet and, in most cases, provides little if any benefit beyond that conferred by such a diet.

Clinicians should also highlight the many advantages of obtaining vitamins and minerals from food instead of from supplements. Micronutrients in food are typically better absorbed by the body and are associated with fewer potential adverse effects. A healthful diet provides an array of nutritionally important substances in biologically optimal ratios as opposed to isolated compounds in highly concentrated form. Indeed, research shows that positive health outcomes are more strongly related to dietary patterns and specific food types than to individual micronutrient or nutrient intakes.

Although routine micronutrient supplementation is not recommended for the general population, targeted supplementation may be warranted in high-risk groups for whom nutritional requirements may not be met through diet alone, including people at certain life stages and those with specific risk factors (discussed in the next 3 sections and in the Box).

Box.Key Points on Vitamin and Mineral Supplements
General Guidance for Supplementation in a Healthy Population by Life Stage

Pregnancy: folic acid, prenatal vitamins

Infants and children: for breastfed infants, vitamin D until weaning and iron from age 4-6 mo

Pregnancy
The evidence is clear that women who may become pregnant or who are in the first trimester of pregnancy should be advised to consume adequate folic acid (0.4-0.8 mg/d) to prevent neural tube defects. Folic acid is one of the few micronutrients more bioavailable in synthetic form from supplements or fortified foods than in the naturally occurring dietary form (folate). Prenatal multivitamin/multimineral supplements will provide folic acid as well as vitamin D and many other essential micronutrients during pregnancy. Pregnant women should also be advised to eat an iron-rich diet. Although it may also be prudent to prescribe supplemental iron for pregnant women with low levels of hemoglobin or ferritin to prevent and treat iron-deficiency anemia, the benefit-risk balance of screening for anemia and routine iron supplementation during pregnancy is not well characterized.

Supplemental calcium may reduce the risk of gestational hypertension and preeclampsia, but confirmatory large trials are needed.2 Use of high-dose vitamin D supplements during pregnancy also warrants further study.2 The American College of Obstetricians and Gynecologists has developed a useful patient handout on micronutrient nutrition during pregnancy.

Infants and Children
The American Academy of Pediatrics recommends that exclusively or partially breastfed infants receive (1) supplemental vitamin D (400 IU/d) starting soon after birth and continuing until weaning to vitamin D–fortified whole milk (≥1 L/d) and (2) supplemental iron (1 mg/kg/d) from 4 months until the introduction of iron-containing foods, usually at 6 months.5 Infants who receive formula, which is fortified with vitamin D and (often) iron, do not typically require additional supplementation. All children should be screened at 1 year for iron deficiency and iron-deficiency anemia.

Healthy children consuming a well-balanced diet do not need multivitamin/multimineral supplements, and they should avoid those containing micronutrient doses that exceed the RDA. In recent years, ω-3 fatty acid supplementation has been viewed as a potential strategy for reducing the risk of autism spectrum disorder or attention-deficit/hyperactivity disorder in children, but evidence from large randomized trials is lacking.

Midlife and Older Adults
With respect to vitamin B12, adults aged 50 years and older may not adequately absorb the naturally occurring, protein-bound form of this nutrient and thus should be advised to meet the RDA (2.4 μg/d) with synthetic B12 found in fortified foods or supplements.6 Patients with pernicious anemia will require higher doses (Box).

Regarding vitamin D, currently recommended intakes (from food or supplements) to maintain bone health are 600 IU/d for adults up to age 70 years and 800 IU/d for those aged older than 70 years. Some professional organizations recommend 1000 to 2000 IU/d, but it has been widely debated whether doses above the RDA offer additional benefits. Ongoing large-scale randomized trials (NCT01169259 and ACTRN12613000743763) should help to resolve continuing uncertainties soon.

With respect to calcium, current RDAs are 1000 mg/d for men aged 51 to 70 years and 1200 mg/d for women aged 51 to 70 years and for all adults aged older than 70 years. Given recent concerns that calcium supplements may increase the risk for kidney stones and possibly cardiovascular disease, patients should aim to meet this recommendation primarily by eating a calcium-rich diet and take calcium supplements only if needed to reach the RDA goal (often only about 500 mg/d in supplements is required).2 A recent meta-analysis suggested that supplementation with moderate-dose calcium (<1000 mg/d) plus vitamin D (≥800 IU/d) might reduce the risk of fractures and loss of bone mass density among postmenopausal women and men aged 65 years and older.

Multivitamin/multimineral supplementation is not recommended for generally healthy adults.8 One large trial in US men found a modest lowering of cancer risk,9 but the results require replication in large trials that include women and allow for analysis by baseline nutrient status, a potentially important modifier of the treatment effect. An ongoing large-scale 4-year trial (NCT02422745) is expected to clarify the benefit-risk balance of multivitamin/multimineral supplements taken for primary prevention of cancer and cardiovascular disease.

Other Key Points
When reviewing medications with patients, clinicians should ask about use of micronutrient (and botanical or other dietary) supplements in counseling about potential interactions. For example, supplemental vitamin K can decrease the effectiveness of warfarin, and biotin (vitamin B7) can interfere with the accuracy of cardiac troponin and other laboratory tests. Patient-friendly interaction checkers are available free of charge online (search for interaction checkers on drugs.com, WebMD, or pharmacy websites).

Clinicians and patients should also be aware that the US Food and Drug Administration is not authorized to review dietary supplements for safety and efficacy prior to marketing. Although supplement makers are required to adhere to the agency’s Good Manufacturing Practice regulations, compliance monitoring is less than optimal. Thus, clinicians may wish to favor prescription products, when available, or advise patients to consider selecting a supplement that has been certified by independent testers (ConsumerLab.com, US Pharmacopeia, NSF International, or UL) to contain the labeled dose(s) of the active ingredient(s) and not to contain microbes, heavy metals, or other toxins. Clinicians (or patients) should report suspected supplement-related adverse effects to the Food and Drug Administration via MedWatch, the online safety reporting portal. An excellent source of information on micronutrient and other dietary supplements for both clinicians and patients is the website of the Office of Dietary Supplements of the National Institutes of Health.

Clinicians have an opportunity to promote appropriate use and to curb inappropriate use of micronutrient supplements, and these efforts are likely to improve public health.

Dietary supplementation is approximately a $30 billion industry in the United States, with more than 90 000 products on the market. In recent national surveys, 52% of US adults reported use of at least 1 supplement product, and 10% reported use of at least 4 such products.1 Vitamins and minerals are among the most popular supplements and are taken by 48% and 39% of adults, respectively, typically to maintain health and prevent disease.

Despite this enthusiasm, most randomized clinical trials of vitamin and mineral supplements have not demonstrated clear benefits for primary or secondary prevention of chronic diseases not related to nutritional deficiency. Indeed, some trials suggest that micronutrient supplementation in amounts that exceed the recommended dietary allowance (RDA)—eg, high doses of beta carotene, folic acid, vitamin E, or selenium—may have harmful effects, including increased mortality, cancer, and hemorrhagic stroke.

In this Viewpoint, we provide information to help clinicians address frequently asked questions about micronutrient supplements from patients, as well as promote appropriate use and curb inappropriate use of such supplements among generally healthy individuals. Importantly, clinicians should counsel their patients that such supplementation is not a substitute for a healthful and balanced diet and, in most cases, provides little if any benefit beyond that conferred by such a diet.

Clinicians should also highlight the many advantages of obtaining vitamins and minerals from food instead of from supplements. Micronutrients in food are typically better absorbed by the body and are associated with fewer potential adverse effects. A healthful diet provides an array of nutritionally important substances in biologically optimal ratios as opposed to isolated compounds in highly concentrated form. Indeed, research shows that positive health outcomes are more strongly related to dietary patterns and specific food types than to individual micronutrient or nutrient intakes.

Although routine micronutrient supplementation is not recommended for the general population, targeted supplementation may be warranted in high-risk groups for whom nutritional requirements may not be met through diet alone, including people at certain life stages and those with specific risk factors (discussed in the next 3 sections and in the Box).

Box.Key Points on Vitamin and Mineral Supplements
General Guidance for Supplementation in a Healthy Population by Life Stage

Pregnancy: folic acid, prenatal vitamins

Infants and children: for breastfed infants, vitamin D until weaning and iron from age 4-6 mo

Pregnancy
The evidence is clear that women who may become pregnant or who are in the first trimester of pregnancy should be advised to consume adequate folic acid (0.4-0.8 mg/d) to prevent neural tube defects. Folic acid is one of the few micronutrients more bioavailable in synthetic form from supplements or fortified foods than in the naturally occurring dietary form (folate). Prenatal multivitamin/multimineral supplements will provide folic acid as well as vitamin D and many other essential micronutrients during pregnancy. Pregnant women should also be advised to eat an iron-rich diet. Although it may also be prudent to prescribe supplemental iron for pregnant women with low levels of hemoglobin or ferritin to prevent and treat iron-deficiency anemia, the benefit-risk balance of screening for anemia and routine iron supplementation during pregnancy is not well characterized.

Supplemental calcium may reduce the risk of gestational hypertension and preeclampsia, but confirmatory large trials are needed.2 Use of high-dose vitamin D supplements during pregnancy also warrants further study.2 The American College of Obstetricians and Gynecologists has developed a useful patient handout on micronutrient nutrition during pregnancy.

Infants and Children
The American Academy of Pediatrics recommends that exclusively or partially breastfed infants receive (1) supplemental vitamin D (400 IU/d) starting soon after birth and continuing until weaning to vitamin D–fortified whole milk (≥1 L/d) and (2) supplemental iron (1 mg/kg/d) from 4 months until the introduction of iron-containing foods, usually at 6 months.5 Infants who receive formula, which is fortified with vitamin D and (often) iron, do not typically require additional supplementation. All children should be screened at 1 year for iron deficiency and iron-deficiency anemia.

Healthy children consuming a well-balanced diet do not need multivitamin/multimineral supplements, and they should avoid those containing micronutrient doses that exceed the RDA. In recent years, ω-3 fatty acid supplementation has been viewed as a potential strategy for reducing the risk of autism spectrum disorder or attention-deficit/hyperactivity disorder in children, but evidence from large randomized trials is lacking.

Midlife and Older Adults
With respect to vitamin B12, adults aged 50 years and older may not adequately absorb the naturally occurring, protein-bound form of this nutrient and thus should be advised to meet the RDA (2.4 μg/d) with synthetic B12 found in fortified foods or supplements.6 Patients with pernicious anemia will require higher doses (Box).

Regarding vitamin D, currently recommended intakes (from food or supplements) to maintain bone health are 600 IU/d for adults up to age 70 years and 800 IU/d for those aged older than 70 years. Some professional organizations recommend 1000 to 2000 IU/d, but it has been widely debated whether doses above the RDA offer additional benefits. Ongoing large-scale randomized trials (NCT01169259 and ACTRN12613000743763) should help to resolve continuing uncertainties soon.

With respect to calcium, current RDAs are 1000 mg/d for men aged 51 to 70 years and 1200 mg/d for women aged 51 to 70 years and for all adults aged older than 70 years. Given recent concerns that calcium supplements may increase the risk for kidney stones and possibly cardiovascular disease, patients should aim to meet this recommendation primarily by eating a calcium-rich diet and take calcium supplements only if needed to reach the RDA goal (often only about 500 mg/d in supplements is required).2 A recent meta-analysis suggested that supplementation with moderate-dose calcium (<1000 mg/d) plus vitamin D (≥800 IU/d) might reduce the risk of fractures and loss of bone mass density among postmenopausal women and men aged 65 years and older.

Multivitamin/multimineral supplementation is not recommended for generally healthy adults.8 One large trial in US men found a modest lowering of cancer risk,9 but the results require replication in large trials that include women and allow for analysis by baseline nutrient status, a potentially important modifier of the treatment effect. An ongoing large-scale 4-year trial (NCT02422745) is expected to clarify the benefit-risk balance of multivitamin/multimineral supplements taken for primary prevention of cancer and cardiovascular disease.

Other Key Points
When reviewing medications with patients, clinicians should ask about use of micronutrient (and botanical or other dietary) supplements in counseling about potential interactions. For example, supplemental vitamin K can decrease the effectiveness of warfarin, and biotin (vitamin B7) can interfere with the accuracy of cardiac troponin and other laboratory tests. Patient-friendly interaction checkers are available free of charge online (search for interaction checkers on drugs.com, WebMD, or pharmacy websites).

Clinicians and patients should also be aware that the US Food and Drug Administration is not authorized to review dietary supplements for safety and efficacy prior to marketing. Although supplement makers are required to adhere to the agency’s Good Manufacturing Practice regulations, compliance monitoring is less than optimal. Thus, clinicians may wish to favor prescription products, when available, or advise patients to consider selecting a supplement that has been certified by independent testers (ConsumerLab.com, US Pharmacopeia, NSF International, or UL) to contain the labeled dose(s) of the active ingredient(s) and not to contain microbes, heavy metals, or other toxins. Clinicians (or patients) should report suspected supplement-related adverse effects to the Food and Drug Administration via MedWatch, the online safety reporting portal. An excellent source of information on micronutrient and other dietary supplements for both clinicians and patients is the website of the Office of Dietary Supplements of the National Institutes of Health.

Clinicians have an opportunity to promote appropriate use and to curb inappropriate use of micronutrient supplements, and these efforts are likely to improve public health.

Enjoy a safe and happy Halloween by following these guidelines from FDA, the Consumer Product Safety Commission, and the Centers for Disease Control and Prevention:
Wear costumes that say “flame resistant” on the label. If you make your costume, use flame-resistant fabrics such as polyester or nylon.Wear bright, reflective costumes or add strips of reflective tape so you’ll be more visible; make sure the costumes aren’t so long that you’re in danger of tripping.Wear makeup and hats rather than masks that can obscure your vision.Test the makeup you plan to use in advance. Put a small amount on the arm of the person who will be wearing it. If a rash, redness, swelling, or other signs of irritation develop where the makeup was applied, that's a sign of a possible allergy.Vibrantly colored makeup is popular at Halloween. Check FDA’s list of color additives to see if the colors are FDA approved. If they aren’t approved for their intended use, don’t use them. This is especially important for colored makeup around the eyes.Don’t wear decorative (colored) contact lenses unless you have seen an eye care professional for a proper fitting and been given instructions for how to use the lenses.

Safe Treats

Eating sweet treats is also a big part of Halloween fun.
Before you or your children go trick-or-treating, remember these tips:
•Don’t eat candy until it has been inspected at home.
•Eat a snack before heading out to avoid the temptation of nibbling on a treat before it has been inspected.
•In case of a food allergy, check the label to ensure the allergen isn’t present. Tell children not to accept—or eat—anything that isn’t commercially wrapped.
•Parents of very young children should remove any choking hazards such as gum, peanuts, hard candies, or small toys from the Halloween bags.
•Inspect commercially wrapped treats for signs of tampering, such as an unusual appearance or discoloration, tiny pinholes, or tears in wrappers. Throw away anything that looks suspicious.

For partygoers and party throwers, FDA recommends the following tips for two seasonal favorites:

•Unpasteurized juices and juices that have not been further processed are at higher risk of food- borne illness. Look for the warning label to identify juice that hasn’t been pasteurized or otherwise processed, especially packaged juice products made on site. If unsure, always ask if juice has been pasteurized or not. Normally, juice in boxes, bottles or cans from your grocer’s frozen food case, refrigerated section, or shelf has been pasteurized.

•Before bobbing for apples—a favorite Halloween game—reduce the risk of bacteria by thoroughly rinsing the apples under cool running water. As an added precaution, use a produce brush to remove surface dirt.

Eye Safety

FDA joins eye care professionals—including the American Academy of Ophthalmology, the American Association for Pediatric Ophthalmology and Strabismus, the Contact Lens Association of Ophthalmologists and the American Optometric Association—in discouraging consumers from using illegal decorative (colored) contact lenses. These are contact lenses that have not been approved by FDA for safety and effectiveness. Consumers should only use brand name contact lenses from well-known contact lens companies.

If you have never worn contact lenses before, Halloween should not be the first time you wear them. Experts warn that buying any kind of contact lenses—which are medical devices and regulated as such—without an examination and a prescription from an eye care professional can cause serious eye disorders and infections, which may lead to permanent vision loss. Despite the fact that it’s illegal to sell decorative contact lenses without a valid prescription, FDA says the lenses are sold on the Internet and in retail shops and salons—particularly around Halloween.

The decorative lenses make the wearer’s eyes appear to glow in the dark, create the illusion of vertical “cat eyes,” or change the wearer’s eye color.

Although unauthorized use of decorative contact lenses is a concern year-round, Halloween is the time when people may be inclined to use them, perhaps as costume accessories. When they are bought and used without a valid prescription, without the involvement of a qualified eye care professional, or without appropriate follow-up care, it can lead to significant risks of eye injuries, including blindness.

Enjoy a safe and happy Halloween by following these guidelines from FDA, the Consumer Product Safety Commission, and the Centers for Disease Control and Prevention:

Wear costumes that say “flame resistant” on the label. If you make your costume, use flame-resistant fabrics such as polyester or nylon.

Wear bright, reflective costumes or add strips of reflective tape so you’ll be more visible; make sure the costumes aren’t so long that you’re in danger of tripping.

Wear makeup and hats rather than masks that can obscure your vision.

Test the makeup you plan to use in advance. Put a small amount on the arm of the person who will be wearing it. If a rash, redness, swelling, or other signs of irritation develop where the makeup was applied, that's a sign of a possible allergy.

Vibrantly colored makeup is popular at Halloween. Check FDA’s list of color additives to see if the colors are FDA approved. If they aren’t approved for their intended use, don’t use them. This is especially important for colored makeup around the eyes.

Don’t wear decorative (colored) contact lenses unless you have seen an eye care professional for a proper fitting and been given instructions for how to use the lenses.

Safe Treats

Eating sweet treats is also a big part of Halloween fun.
Before you or your children go trick-or-treating, remember these tips:
•Don’t eat candy until it has been inspected at home.
•Eat a snack before heading out to avoid the temptation of nibbling on a treat before it has been inspected.
•In case of a food allergy, check the label to ensure the allergen isn’t present. Tell children not to accept—or eat—anything that isn’t commercially wrapped.
•Parents of very young children should remove any choking hazards such as gum, peanuts, hard candies, or small toys from the Halloween bags.
•Inspect commercially wrapped treats for signs of tampering, such as an unusual appearance or discoloration, tiny pinholes, or tears in wrappers. Throw away anything that looks suspicious.

For partygoers and party throwers, FDA recommends the following tips for two seasonal favorites:

•Unpasteurized juices and juices that have not been further processed are at higher risk of food- borne illness. Look for the warning label to identify juice that hasn’t been pasteurized or otherwise processed, especially packaged juice products made on site. If unsure, always ask if juice has been pasteurized or not. Normally, juice in boxes, bottles or cans from your grocer’s frozen food case, refrigerated section, or shelf has been pasteurized.

•Before bobbing for apples—a favorite Halloween game—reduce the risk of bacteria by thoroughly rinsing the apples under cool running water. As an added precaution, use a produce brush to remove surface dirt.

Eye Safety

FDA joins eye care professionals—including the American Academy of Ophthalmology, the American Association for Pediatric Ophthalmology and Strabismus, the Contact Lens Association of Ophthalmologists and the American Optometric Association—in discouraging consumers from using illegal decorative (colored) contact lenses. These are contact lenses that have not been approved by FDA for safety and effectiveness. Consumers should only use brand name contact lenses from well-known contact lens companies.

If you have never worn contact lenses before, Halloween should not be the first time you wear them. Experts warn that buying any kind of contact lenses—which are medical devices and regulated as such—without an examination and a prescription from an eye care professional can cause serious eye disorders and infections, which may lead to permanent vision loss. Despite the fact that it’s illegal to sell decorative contact lenses without a valid prescription, FDA says the lenses are sold on the Internet and in retail shops and salons—particularly around Halloween.

The decorative lenses make the wearer’s eyes appear to glow in the dark, create the illusion of vertical “cat eyes,” or change the wearer’s eye color.

Although unauthorized use of decorative contact lenses is a concern year-round, Halloween is the time when people may be inclined to use them, perhaps as costume accessories. When they are bought and used without a valid prescription, without the involvement of a qualified eye care professional, or without appropriate follow-up care, it can lead to significant risks of eye injuries, including blindness.

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Have you told someone about being bullied and nothing has changed? Don’t give up! Did you know that you have the legal right to be safe at school? If the bullying continues even after you told an adult, know that there are laws designed to protect you (find your state law or policy at StopBullying.gov). It is very important for students to reach out to another trusted adult and ask for help again. This adult can be a parent, a teacher, a coach, or anyone from the community. Let them know that you need their help and that you wouldn’t be coming to them if you could fix the situation on your own.

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If you told an adult about a bullying situation and it wasn’t helpful, don’t give up! Be a self-advocate. Speak up for yourself and let another adult know what you need in order to feel safe. Every student has the right to feel safe at school.

All states have laws or policies to address bullying prevention in schools. Some adults may not be aware of these laws or realize that the school has a bullying prevention policy in place. Share your knowledge that there is a law, and keep talking until someone understands and gives you support. There are people who care and will help you.

When speaking to a trusted adult, whether it be a school administrator, a teacher, counselor, or another adult in the community, share important information with them, such as:
a description of the bullyinga reminder that there are laws outlining the school’s responsibility in handling bullying situationsa discussion of the school’s bullying prevention policy

You may have additional protections when the bullying is about race, color, national origin, age, sex, religion, or disability. This is called harassment and there is a federal law.

On your own, or with the help of an adult, create an action plan. Write down what is happening to you with details about where it happens and who is involved. Think about what you can do to change your situation or what would help you gain control over the situation. PACER’s Student Action Plan can be a great place to start this process.

Bullying hurts, it’s emotional, but know that you do not have to deal with it alone. The first person may not have been able to help, but keep going. There are adults who will listen, be there for you, and support you.

Blog
Read the article written by PACER staff, which was posted to Disney’s Babble blog: Speaking up about bullying isn’t tattling and our kids need to know the difference.

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Have you told someone about being bullied and nothing has changed? Don’t give up! Did you know that you have the legal right to be safe at school? If the bullying continues even after you told an adult, know that there are laws designed to protect you (find your state law or policy at StopBullying.gov). It is very important for students to reach out to another trusted adult and ask for help again. This adult can be a parent, a teacher, a coach, or anyone from the community. Let them know that you need their help and that you wouldn’t be coming to them if you could fix the situation on your own.

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If you told an adult about a bullying situation and it wasn’t helpful, don’t give up! Be a self-advocate. Speak up for yourself and let another adult know what you need in order to feel safe. Every student has the right to feel safe at school.

All states have laws or policies to address bullying prevention in schools. Some adults may not be aware of these laws or realize that the school has a bullying prevention policy in place. Share your knowledge that there is a law, and keep talking until someone understands and gives you support. There are people who care and will help you.

When speaking to a trusted adult, whether it be a school administrator, a teacher, counselor, or another adult in the community, share important information with them, such as:

a description of the bullying

a reminder that there are laws outlining the school’s responsibility in handling bullying situations

a discussion of the school’s bullying prevention policy

You may have additional protections when the bullying is about race, color, national origin, age, sex, religion, or disability. This is called harassment and there is a federal law.

On your own, or with the help of an adult, create an action plan. Write down what is happening to you with details about where it happens and who is involved. Think about what you can do to change your situation or what would help you gain control over the situation. PACER’s Student Action Plan can be a great place to start this process.

Bullying hurts, it’s emotional, but know that you do not have to deal with it alone. The first person may not have been able to help, but keep going. There are adults who will listen, be there for you, and support you.

Blog
Read the article written by PACER staff, which was posted to Disney’s Babble blog: Speaking up about bullying isn’t tattling and our kids need to know the difference.

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When your child is the target of bullying, a parent’s first response is often an emotional one, followed by a sense of wanting to know the most effective, action-oriented response. Building positive relationships between the school, parents, and students will ensure that a plan and timeline of action can be quickly set in place to prevent further bullying.

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It can be heartbreaking for parents to learn that their child is being bullied at school. It is difficult for parents to know what to do when a report of bullying is made, and if they should have done something ahead of time that might have influenced what happened to their child. Developing positive relationships with teachers and staff, while using effective communication tools, can help greatly when dealing with a difficult situation such as bullying.

Staff are often the first adults to learn about a school bullying situation, and they can identify different patterns and social patterns with students than parents do at home. Partnerships between parents and school personnel is one of the best ways to prevent further bullying and is essential when bullying is happening at school.

Here are some best practices to guide parents working with school staff toward a healthier and safer school environment for their child:

Speak with an adult at school who knows your child well
Do establish a relationship with your child’s teachers at the beginning of the school year.Do immediately contact a teacher or another staff member (such as the principal or an advisor) who is close to your child if there is a report of bullying.Do understand that they may redirect you to the appropriate person. In some schools this is the dean of students; in other schools, it might be the vice principal who is responsible for bullying and discipline issues. The information on who to contact and how the process will be addressed should be available on your school’s website, from school administration, or in your parent handbook.

Keeping records and written information
Do document and create a timeline for what your child has told you with dates, times, and people involved in the bullying.Do note who you speak to at the school.Do ask about the timing of the follow-up process and who will be getting back to you.Do create a paper file that will hold hard copies of everything.Do keep documentation in that file of all communication with the school, including emails, calls, and letters.Do keep a history of any bullying behavior, documenting face-to-face incidents, or the screenshots, texts, or URLs of bullying directed at your child.

Meeting with school staff
Do bring your file with you, and prepare questions and a list of priorities and concerns to discuss. Know that it’s possible you will feel stressed; try to stay calm and communicate what your child needs as clearly as possible. Ask in advance what the purpose of the meeting will be and who will be there.Do make sure that there is an agenda and that your items are on it.Do repeat what you’ve heard so that you can be sure of what school staff are saying.Do summarize the outcomes at the end of the meeting.Do determine who will be responsible for future steps.Do offer thanks for what staff have done so far and what will happen in the future for your child.

Asking questions
Do ask what, who, when, where, and how questions.Do follow up with constructive phrases such as:

“Tell me more about…”“Please explain…”“What do you suggest we do about…”“I think I heard you say… is that correct”

Creating a plan
Do describe the problem clearly while encouraging input from all members of the team.Do allow for brainstorming without evaluating the ideas.Do participate in the brainstorming as an advocate for your child’s needs.Do ask your child for their feedback and ideas on what they’d like to see happen.Do choose a solution by consensus (all parties in agreement). Define who is responsible for an action and when it will be done.Do put that plan in writing, and create a timeline and criteria to evaluate success.Do understand that participation and follow up will be needed from everyone.

While bullying is a difficult situation for everyone involved, a good partnership between the school and parents can help address the situation and prevent further bullying. Using the best practices of good communication strategies and planning, parents can collaborate with the school to ensure a good outcome for their child, whatever the problem.

More details can be found at the interactive online module PACER.org/bullying/resources/parents/working-with-school.asp.

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When your child is the target of bullying, a parent’s first response is often an emotional one, followed by a sense of wanting to know the most effective, action-oriented response. Building positive relationships between the school, parents, and students will ensure that a plan and timeline of action can be quickly set in place to prevent further bullying.

完整版

It can be heartbreaking for parents to learn that their child is being bullied at school. It is difficult for parents to know what to do when a report of bullying is made, and if they should have done something ahead of time that might have influenced what happened to their child. Developing positive relationships with teachers and staff, while using effective communication tools, can help greatly when dealing with a difficult situation such as bullying.

Staff are often the first adults to learn about a school bullying situation, and they can identify different patterns and social patterns with students than parents do at home. Partnerships between parents and school personnel is one of the best ways to prevent further bullying and is essential when bullying is happening at school.

Here are some best practices to guide parents working with school staff toward a healthier and safer school environment for their child:

Speak with an adult at school who knows your child well

Do establish a relationship with your child’s teachers at the beginning of the school year.

Do immediately contact a teacher or another staff member (such as the principal or an advisor) who is close to your child if there is a report of bullying.

Do understand that they may redirect you to the appropriate person. In some schools this is the dean of students; in other schools, it might be the vice principal who is responsible for bullying and discipline issues. The information on who to contact and how the process will be addressed should be available on your school’s website, from school administration, or in your parent handbook.

Keeping records and written information

Do document and create a timeline for what your child has told you with dates, times, and people involved in the bullying.

Do note who you speak to at the school.

Do ask about the timing of the follow-up process and who will be getting back to you.

Do create a paper file that will hold hard copies of everything.

Do keep documentation in that file of all communication with the school, including emails, calls, and letters.

Do keep a history of any bullying behavior, documenting face-to-face incidents, or the screenshots, texts, or URLs of bullying directed at your child.

Meeting with school staff

Do bring your file with you, and prepare questions and a list of priorities and concerns to discuss. Know that it’s possible you will feel stressed; try to stay calm and communicate what your child needs as clearly as possible. Ask in advance what the purpose of the meeting will be and who will be there.

Do make sure that there is an agenda and that your items are on it.

Do repeat what you’ve heard so that you can be sure of what school staff are saying.

Do summarize the outcomes at the end of the meeting.

Do determine who will be responsible for future steps.

Do offer thanks for what staff have done so far and what will happen in the future for your child.

Asking questions

Do ask what, who, when, where, and how questions.

Do follow up with constructive phrases such as:

“Tell me more about…”

“Please explain…”

“What do you suggest we do about…”

“I think I heard you say… is that correct”

Creating a plan

Do describe the problem clearly while encouraging input from all members of the team.

Do allow for brainstorming without evaluating the ideas.

Do participate in the brainstorming as an advocate for your child’s needs.

Do ask your child for their feedback and ideas on what they’d like to see happen.

Do choose a solution by consensus (all parties in agreement). Define who is responsible for an action and when it will be done.

Do put that plan in writing, and create a timeline and criteria to evaluate success.

Do understand that participation and follow up will be needed from everyone.

While bullying is a difficult situation for everyone involved, a good partnership between the school and parents can help address the situation and prevent further bullying. Using the best practices of good communication strategies and planning, parents can collaborate with the school to ensure a good outcome for their child, whatever the problem.

More details can be found at the interactive online module PACER.org/bullying/resources/parents/working-with-school.asp.

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When a child is bullying others, it’s important that parents and educators take action. It is equally important for adults to recognize that bullying is about behavior, and they should choose responses that acknowledge behavior can be changed. Reframing the focus from labeling a child as a “bully” to referring to them as a “child with bullying behavior” recognizes that there is capacity for change. While children who are bullying others should be given appropriate consequences for their behavior, adults should be talking with their children to learn why they are bullying others. Children need to understand the impact their behavior has on others and realize the hurt they are causing. With adult guidance, redirecting bullying behavior toward an understanding of differences, as well as the practices of kindness and inclusion, are good strategies for reshaping a child’s behavior.

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Bullying is a learned behavior — and it can be “unlearned” and replaced with more positive behaviors. By talking with your child and taking action, you can teach your child more appropriate ways of handling feelings and responding to peer pressure and conflicts.

While it is important to look into any report of bullying and have it stopped quickly, it is good to remember that children are still developing an awareness of the skills they need to maintain healthy relationships. Their behavior can and does change throughout childhood as their identity is formed.

Finding strategies to assist with the development of positive behaviors can influence bullying behavior in children, at home, or at school. If you suspect or know that your child has been bullying others, here are some things to do right away and on an ongoing basis:
Talk with your child. Children may not always recognize their behavior as bullying. They may see it as “just having fun” and not realize the impact it has on another child. Help them understand what defines bullying and emphasize that this behavior is never appropriate.Explore reasons for the behavior. Find out why your child is behaving in a manner that is harmful to others through an open, nonjudgmental discussion. Here are some helpful tips on having that conversation.Confirm that your child’s behavior is bullying and not the result of a disability. Sometimes, children with disabilities who have certain emotional and behavioral disorders, or are in the process of developing social skills, may act in ways that are mistaken for bullying.Develop an action plan. It’s important to think through the steps that work for you, your child, and your situation. A good tool to use is this Student Action Plan.Teach empathy, respect, and compassion. Children who bully often lack awareness of how others feel or understand how their actions impact someone else. Try to understand your child’s feelings and help your child appreciate how others feel when they are bullied. Let your child know that everyone has feelings and that feelings matter.Make your expectations clear. Let your child know that bullying is not okay under any circumstances and that you will not tolerate it. Let them know that there will be consequences for their behavior. Take immediate action if you learn that he or she is involved in a bullying incident.Provide clear and consistent consequences for bullying. Be specific about what will happen if the bullying continues. Try to find meaningful consequences that fit the situation, such as loss of privileges or activities. If the behavior does not change, consider increasing the significance of the consequences.Teach by example. Help your child learn different ways to resolve conflict and deal with feelings, such as anger, insecurity, or frustration. Teach and reward appropriate behavior.Provide positive feedback. When your child handles conflict well, shows compassion for others, or find a positive way to deal with feelings, provide praise and recognition. Positive reinforcement can help improve behavior and is usually more effective than punishment.Be realistic. It takes time to change behavior. Recognize that there may be setbacks. Be patient as your child learns new ways of handling feelings and conflict. Keep your concern and support visible.

Speaking with school personnel and developing a collaborative relationship with school staff can also be very helpful in changing a child’s behavior. Reach out to those who work with your child at school and share information about your concerns.

Here are some other tips for establishing relationships in your child's school or community:
Establish good communication with your child’s teachers and coaches at the start of the school year.Speak with school staff. Talk to the principal, dean, counselor, or social worker to determine if the school offers a bullying prevention program and how your child might be involved.Research ways for your child to be involved in groups that encourage cooperative relationships and focus on working with others.Seek help from your community. It’s important to find resources in both the school and community. Your child’s doctor, leaders of youth groups, coaches, or mental health practitioners can help you and your child learn how to understand and deal with bullying behavior.

博客

Read the article written by PACER staff, which was posted to Disney’s Babble blog:, What if Your Child Is the One Doing the Bullying?

浓缩版
When a child is bullying others, it’s important that parents and educators take action. It is equally important for adults to recognize that bullying is about behavior, and they should choose responses that acknowledge behavior can be changed. Reframing the focus from labeling a child as a “bully” to referring to them as a “child with bullying behavior” recognizes that there is capacity for change. While children who are bullying others should be given appropriate consequences for their behavior, adults should be talking with their children to learn why they are bullying others. Children need to understand the impact their behavior has on others and realize the hurt they are causing. With adult guidance, redirecting bullying behavior toward an understanding of differences, as well as the practices of kindness and inclusion, are good strategies for reshaping a child’s behavior.

完整版

Bullying is a learned behavior — and it can be “unlearned” and replaced with more positive behaviors. By talking with your child and taking action, you can teach your child more appropriate ways of handling feelings and responding to peer pressure and conflicts.

While it is important to look into any report of bullying and have it stopped quickly, it is good to remember that children are still developing an awareness of the skills they need to maintain healthy relationships. Their behavior can and does change throughout childhood as their identity is formed.

Finding strategies to assist with the development of positive behaviors can influence bullying behavior in children, at home, or at school. If you suspect or know that your child has been bullying others, here are some things to do right away and on an ongoing basis:

Talk with your child. Children may not always recognize their behavior as bullying. They may see it as “just having fun” and not realize the impact it has on another child. Help them understand what defines bullying and emphasize that this behavior is never appropriate.

Explore reasons for the behavior. Find out why your child is behaving in a manner that is harmful to others through an open, nonjudgmental discussion. Here are some helpful tips on having that conversation.

Confirm that your child’s behavior is bullying and not the result of a disability. Sometimes, children with disabilities who have certain emotional and behavioral disorders, or are in the process of developing social skills, may act in ways that are mistaken for bullying.

Develop an action plan. It’s important to think through the steps that work for you, your child, and your situation. A good tool to use is this Student Action Plan.

Teach empathy, respect, and compassion. Children who bully often lack awareness of how others feel or understand how their actions impact someone else. Try to understand your child’s feelings and help your child appreciate how others feel when they are bullied. Let your child know that everyone has feelings and that feelings matter.

Make your expectations clear. Let your child know that bullying is not okay under any circumstances and that you will not tolerate it. Let them know that there will be consequences for their behavior. Take immediate action if you learn that he or she is involved in a bullying incident.

Provide clear and consistent consequences for bullying. Be specific about what will happen if the bullying continues. Try to find meaningful consequences that fit the situation, such as loss of privileges or activities. If the behavior does not change, consider increasing the significance of the consequences.

Teach by example. Help your child learn different ways to resolve conflict and deal with feelings, such as anger, insecurity, or frustration. Teach and reward appropriate behavior.

Provide positive feedback. When your child handles conflict well, shows compassion for others, or find a positive way to deal with feelings, provide praise and recognition. Positive reinforcement can help improve behavior and is usually more effective than punishment.

Be realistic. It takes time to change behavior. Recognize that there may be setbacks. Be patient as your child learns new ways of handling feelings and conflict. Keep your concern and support visible.

Speaking with school personnel and developing a collaborative relationship with school staff can also be very helpful in changing a child’s behavior. Reach out to those who work with your child at school and share information about your concerns.

Here are some other tips for establishing relationships in your child's school or community:

Establish good communication with your child’s teachers and coaches at the start of the school year.

Speak with school staff. Talk to the principal, dean, counselor, or social worker to determine if the school offers a bullying prevention program and how your child might be involved.

Research ways for your child to be involved in groups that encourage cooperative relationships and focus on working with others.

Seek help from your community. It’s important to find resources in both the school and community. Your child’s doctor, leaders of youth groups, coaches, or mental health practitioners can help you and your child learn how to understand and deal with bullying behavior.

博客

Read the article written by PACER staff, which was posted to Disney’s Babble blog:, What if Your Child Is the One Doing the Bullying?

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PACER’s National Bullying Prevention Center uses the term “bullying prevention” instead of “anti-bullying” to place the emphasis on a proactive approach and philosophy, framing bullying as an issue to which there is a solution. While the use of “anti” does appropriately indicate the concept of being against bullying, the focus on “prevention” recognizes that change is ultimately about shifting behavior and attitudes, which can happen through the positive approach of education, awareness, and action.

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At PACER’s National Bullying Prevention Center, our vision is “to make every child safe and to change the culture in our society so that bullying is no longer viewed as acceptable behavior.” The language framing the goal is an important part of this change. It has the potential to influence the view of the issue and, in the best cases, direct ideas that promote positive behavior.

Using the term “bullying prevention” instead of “anti-bullying” places the focus where it should be: on understanding the actions that help prevent bullying from occurring. A term, such as “anti,” which focuses on the negative, often doesn’t allow for the opportunity to change or indicate what society can do about bullying.

Acting to change the behavior is vitally important to preventing bullying. Bullying should not be considered a childhood rite of passage. Instead, bullying behaviors should be viewed as changeable and preventable through education and awareness. Discussions with children that focus on inclusion over exclusion, and showing respect and kindness toward others need to occur frequently as children grow up. When children are brought to better awareness of these issues, they have a greater opportunity to develop empathy and an increased understanding that can ultimately disrupt or interrupt bullying dynamics.

In these ongoing conversations with children or throughout communities, to create a social environment where bullying is not accepted, include discussions on how bullying harms everyone involved — targets, witnesses, and the people who use these damaging behaviors. While “anti” does appropriately express being against bullying, the conversation must include preventative efforts. Discussing the steps necessary to resolve conflicts and promote healthy social interactions between people will lead to a culture focusing on a positive, proactive approach to preventing bullying.

浓缩版
PACER’s National Bullying Prevention Center uses the term “bullying prevention” instead of “anti-bullying” to place the emphasis on a proactive approach and philosophy, framing bullying as an issue to which there is a solution. While the use of “anti” does appropriately indicate the concept of being against bullying, the focus on “prevention” recognizes that change is ultimately about shifting behavior and attitudes, which can happen through the positive approach of education, awareness, and action.

完整版

At PACER’s National Bullying Prevention Center, our vision is “to make every child safe and to change the culture in our society so that bullying is no longer viewed as acceptable behavior.” The language framing the goal is an important part of this change. It has the potential to influence the view of the issue and, in the best cases, direct ideas that promote positive behavior.

Using the term “bullying prevention” instead of “anti-bullying” places the focus where it should be: on understanding the actions that help prevent bullying from occurring. A term, such as “anti,” which focuses on the negative, often doesn’t allow for the opportunity to change or indicate what society can do about bullying.

Acting to change the behavior is vitally important to preventing bullying. Bullying should not be considered a childhood rite of passage. Instead, bullying behaviors should be viewed as changeable and preventable through education and awareness. Discussions with children that focus on inclusion over exclusion, and showing respect and kindness toward others need to occur frequently as children grow up. When children are brought to better awareness of these issues, they have a greater opportunity to develop empathy and an increased understanding that can ultimately disrupt or interrupt bullying dynamics.

In these ongoing conversations with children or throughout communities, to create a social environment where bullying is not accepted, include discussions on how bullying harms everyone involved — targets, witnesses, and the people who use these damaging behaviors. While “anti” does appropriately express being against bullying, the conversation must include preventative efforts. Discussing the steps necessary to resolve conflicts and promote healthy social interactions between people will lead to a culture focusing on a positive, proactive approach to preventing bullying.

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Friends will sometimes have bad days. Friends will sometimes disagree. Friends will sometimes hurt each other's feelings, have an argument, or simply need time away from one another. This is normal and can happen in any friendship, no matter how close. If you are experiencing treatment from a friend that hurts you and you have asked that friend to stop, but it still continues, then that is not friendship. That behavior could be bullying. Friendship behaviors do not include hurting someone on purpose or continually being mean even when asked to stop. A friend will change or be remorseful for her behavior if she finds out she's hurting you. If you aren't certain if what is happening is part of a normal friendship or if it is bullying, talk to an adult you trust and get help sorting out the relationship. And yes, it is okay (and the right thing to do) to ask for help.

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Is it possible that someone we call a friend, or even a best friend, is the very person that treats us the worst? How can the person with whom we share jokes, snacks, and secrets be someone who hurts us?

With relationships, it’s natural to have conflict as we learn how to be friends and communicate. Sometimes we make mistakes with friends, hurt their feelings, apologize for what we’ve done, and move on. Through making mistakes in our relationships, we learn what to do with the people around us — as well as what not to do. It’s normal to have conflicts or disagreements with friends as we grow up; that’s how we learn to be better friends and communicators.

What’s not okay — and is never deserved — is when someone we are close to decides to threaten us, to hurt our feelings intentionally, misuse our trust, or make us feel less than who we are. If someone we call a friend repeatedly uses bullying behavior — such as belittling who we are, trying to control us, or attempting to tell us who we can be friends with — that’s no longer a friend. That type of behavior is outside of friendship in every way and has to be called what it is: bullying.

This is a painful and sometimes unacknowledged type of bullying that is hard to understand and even harder to endure. Here’s how to recognize when those we are close to are bullying us, even though we call them “friends.”

Below are some examples to help recognize if bullying is happening in your relationships:
You are made fun of, called names, or teased for your appearance or what you wearYou are mocked or mimicked for what you say or how you actYou are laughed at when people know you’re hurting from being teased or physically abusedYou are told who you can be friends with or what you can and can’t doYou are purposefully excluded from events or get-togethers in which other friends are invitedYou have told your friends to stop the negative behavior and they continue anywayYou are made to feel that you don’t live up to the standards of the friend group

If you or someone you care about is being bullied by a “friend,” please find an adult you trust and tell them what’s going on as soon as possible. Bullying like this often does not stop without intervention. Bullying like this doesn’t go away if you ignore it either. This type of situation will need assistance and advice on making a plan for what to do.

You’ll also need allies, people around you at school or in your neighborhood who will actively support you and have your back. An ally will stand up for you if she feels safe, or be a witness to what’s going on and be able to tell an adult what she saw happen. An ally can help you feel less alone, too, which is a very good thing.

Don’t hesitate for too long when someone you call a friend is repeatedly disrespectful to you and causes you pain when you’ve asked them to stop. If you find you’re always nervous and anxious around a friend because you’re worried about what they might say or do to you, talk to an adult and work out what’s happening. Sometimes it will be a normal consequence of learning to be friends, and sometimes it will be bullying. If it’s bullying, that’s not friendship and it probably never will be. You have the right to be around people who treat you like a friend, and that you can respect and trust.

Teen Perspective

The following is excerpted from a response to a question submitted for the ASK JAMIE column on PACERTeensAgainstBullying.com.

The question came from Scarlett, a 7th grader, who wrote, “I love my friends, but sometimes I feel like they don’t like me much. At school they call me names all the time, then they say they are just joking, but it feels mean and sometimes I feel excluded and sad.”

Ask Jamie’s response: It sounds like you have been facing bullying from your friends but feel unsure of how to handle it, especially since it is veiled as “just a joke.” This is something I, and many others, relate to. It is difficult to know how to respond to a friend who says hurtful comments, since oftentimes they will defend themselves with the “joke” cover.

A general guideline is: If you don’t find it funny but do find it hurtful, then it isn’t okay.

Your friend may very well have intended the comment as a joke, but it is the way it makes you feel that matters. If you feel hurt, unsafe, or targeted by the joke, then ask your friends to stop. If it happens again, and as long as you stay safe, say something like: “I know you probably think that you are just kidding, but the comments you have made are really hurtful, so I would really appreciate if you would stop. I know that if you realized how much your words affected me, you would stop.”

If they cannot respect your requests, then they are not being true friends and, therefore, may not deserve your friendship. Realize that you deserved to be treated with kindness, so any friendships that are offering meanness should be evaluated and its your decision about whether or not to continue the relationship.

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Friends will sometimes have bad days. Friends will sometimes disagree. Friends will sometimes hurt each other's feelings, have an argument, or simply need time away from one another. This is normal and can happen in any friendship, no matter how close. If you are experiencing treatment from a friend that hurts you and you have asked that friend to stop, but it still continues, then that is not friendship. That behavior could be bullying. Friendship behaviors do not include hurting someone on purpose or continually being mean even when asked to stop. A friend will change or be remorseful for her behavior if she finds out she's hurting you. If you aren't certain if what is happening is part of a normal friendship or if it is bullying, talk to an adult you trust and get help sorting out the relationship. And yes, it is okay (and the right thing to do) to ask for help.

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Is it possible that someone we call a friend, or even a best friend, is the very person that treats us the worst? How can the person with whom we share jokes, snacks, and secrets be someone who hurts us?

With relationships, it’s natural to have conflict as we learn how to be friends and communicate. Sometimes we make mistakes with friends, hurt their feelings, apologize for what we’ve done, and move on. Through making mistakes in our relationships, we learn what to do with the people around us — as well as what not to do. It’s normal to have conflicts or disagreements with friends as we grow up; that’s how we learn to be better friends and communicators.

What’s not okay — and is never deserved — is when someone we are close to decides to threaten us, to hurt our feelings intentionally, misuse our trust, or make us feel less than who we are. If someone we call a friend repeatedly uses bullying behavior — such as belittling who we are, trying to control us, or attempting to tell us who we can be friends with — that’s no longer a friend. That type of behavior is outside of friendship in every way and has to be called what it is: bullying.

This is a painful and sometimes unacknowledged type of bullying that is hard to understand and even harder to endure. Here’s how to recognize when those we are close to are bullying us, even though we call them “friends.”

Below are some examples to help recognize if bullying is happening in your relationships:

You are made fun of, called names, or teased for your appearance or what you wear

You are mocked or mimicked for what you say or how you act

You are laughed at when people know you’re hurting from being teased or physically abused

You are told who you can be friends with or what you can and can’t do

You are purposefully excluded from events or get-togethers in which other friends are invited

You have told your friends to stop the negative behavior and they continue anyway

You are made to feel that you don’t live up to the standards of the friend group

If you or someone you care about is being bullied by a “friend,” please find an adult you trust and tell them what’s going on as soon as possible. Bullying like this often does not stop without intervention. Bullying like this doesn’t go away if you ignore it either. This type of situation will need assistance and advice on making a plan for what to do.

You’ll also need allies, people around you at school or in your neighborhood who will actively support you and have your back. An ally will stand up for you if she feels safe, or be a witness to what’s going on and be able to tell an adult what she saw happen. An ally can help you feel less alone, too, which is a very good thing.

Don’t hesitate for too long when someone you call a friend is repeatedly disrespectful to you and causes you pain when you’ve asked them to stop. If you find you’re always nervous and anxious around a friend because you’re worried about what they might say or do to you, talk to an adult and work out what’s happening. Sometimes it will be a normal consequence of learning to be friends, and sometimes it will be bullying. If it’s bullying, that’s not friendship and it probably never will be. You have the right to be around people who treat you like a friend, and that you can respect and trust.

Teen Perspective

The following is excerpted from a response to a question submitted for the ASK JAMIE column on PACERTeensAgainstBullying.com.

The question came from Scarlett, a 7th grader, who wrote, “I love my friends, but sometimes I feel like they don’t like me much. At school they call me names all the time, then they say they are just joking, but it feels mean and sometimes I feel excluded and sad.”

Ask Jamie’s response: It sounds like you have been facing bullying from your friends but feel unsure of how to handle it, especially since it is veiled as “just a joke.” This is something I, and many others, relate to. It is difficult to know how to respond to a friend who says hurtful comments, since oftentimes they will defend themselves with the “joke” cover.

A general guideline is: If you don’t find it funny but do find it hurtful, then it isn’t okay.

Your friend may very well have intended the comment as a joke, but it is the way it makes you feel that matters. If you feel hurt, unsafe, or targeted by the joke, then ask your friends to stop. If it happens again, and as long as you stay safe, say something like: “I know you probably think that you are just kidding, but the comments you have made are really hurtful, so I would really appreciate if you would stop. I know that if you realized how much your words affected me, you would stop.”

If they cannot respect your requests, then they are not being true friends and, therefore, may not deserve your friendship. Realize that you deserved to be treated with kindness, so any friendships that are offering meanness should be evaluated and its your decision about whether or not to continue the relationship.

浓缩版
Bullying and harassment are often used interchangeably when talking about hurtful or harmful behavior. They are very similar, but in terms of definition, there is an important difference.

Bullying and harassment are similar as they are both about:
power and controlactions that hurt or harm another person physically or emotionallyan imbalance of power between the target and the individual demonstrating the negative behaviorthe target having difficulty stopping the action directed at them

The distinction between bullying and harassment is that when the bullying behavior directed at the target is also based on a protected class, that behavior is then defined as harassment. Protected classes include:
racecolorreligionsexagedisabilitynational origin

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Although bullying and harassment are often used interchangeably when talking about hurtful or harmful behavior — and the behavior may look the same — there are important distinctions in the definition, laws, and protections for students experiencing harassment.

The first difference is in the definitions of bullying and harassment. For bullying, it’s important to note that while definitions vary from source to source, most agree that an act is defined as bullying when the behavior hurts, harms, or humiliates another person physically or emotionally. Those targeted by bullying behavior struggle to defend themselves and stop the action directed at them. There also is an “imbalance of power.” This means the student demonstrating the bullying behavior has more power; this can be physically, socially, or emotionally (for example, a higher social status, physically larger, or emotionally intimidating).

The definition of harassment outlines that the behavior is similar by its unwanted and hurtful actions. It can include unwelcome conduct such as verbal abuse, graphic or written statements, threats, physical assault, or other conduct that is threatening or humiliating, but the negative behavior is based on a student’s race, color, religion, sex, age, disability, or national origin. For example, bullying behavior meets the threshold of harassment when a student is being verbally bullied with demeaning language about their disability.

Students experiencing harassment also have protections at the federal level. The Office of Civil Rights (OCR) and the Department of Justice (DOJ) have stated that bullying is considered discriminatory harassment when based on a student’s race, color, religion, sex, age, disability, or national origin. If a student is experiencing discriminatory harassment, federally funded schools are obligated under federal law to address the behavior.

If you’re looking for more information on how schools are required to address the behavior, visit stopbullying.gov.

浓缩版
Bullying and harassment are often used interchangeably when talking about hurtful or harmful behavior. They are very similar, but in terms of definition, there is an important difference.

Bullying and harassment are similar as they are both about:

power and control

actions that hurt or harm another person physically or emotionally

an imbalance of power between the target and the individual demonstrating the negative behavior

the target having difficulty stopping the action directed at them

The distinction between bullying and harassment is that when the bullying behavior directed at the target is also based on a protected class, that behavior is then defined as harassment. Protected classes include:

race

color

religion

sex

age

disability

national origin

完整版

Although bullying and harassment are often used interchangeably when talking about hurtful or harmful behavior — and the behavior may look the same — there are important distinctions in the definition, laws, and protections for students experiencing harassment.

The first difference is in the definitions of bullying and harassment. For bullying, it’s important to note that while definitions vary from source to source, most agree that an act is defined as bullying when the behavior hurts, harms, or humiliates another person physically or emotionally. Those targeted by bullying behavior struggle to defend themselves and stop the action directed at them. There also is an “imbalance of power.” This means the student demonstrating the bullying behavior has more power; this can be physically, socially, or emotionally (for example, a higher social status, physically larger, or emotionally intimidating).

The definition of harassment outlines that the behavior is similar by its unwanted and hurtful actions. It can include unwelcome conduct such as verbal abuse, graphic or written statements, threats, physical assault, or other conduct that is threatening or humiliating, but the negative behavior is based on a student’s race, color, religion, sex, age, disability, or national origin. For example, bullying behavior meets the threshold of harassment when a student is being verbally bullied with demeaning language about their disability.

Students experiencing harassment also have protections at the federal level. The Office of Civil Rights (OCR) and the Department of Justice (DOJ) have stated that bullying is considered discriminatory harassment when based on a student’s race, color, religion, sex, age, disability, or national origin. If a student is experiencing discriminatory harassment, federally funded schools are obligated under federal law to address the behavior.

If you’re looking for more information on how schools are required to address the behavior, visit stopbullying.gov.

Many kids (and parents) who have seen Luke Skywalker battle Darth Vader with a light saber think lasers are cool.

What they may not know is this: When operated unsafely, or without certain controls, the highly-concentrated light from lasers—even those in toys—can be dangerous, causing serious eye injuries and even blindness. And not just to the person using a laser, but to anyone within range of the laser beam.

The U.S. Food and Drug Administration is concerned about this potential danger to children and those around them and in 2014 issued a guidance document (PDF 60K) on the safety of children’s toy laser products.

“A beam shone directly into a person’s eye can injure it in an instant, especially if the laser is a powerful one,” explains Dan Hewett, health promotion officer at the FDA’s Center for Devices and Radiological Health.

Moreover, eye injuries caused by laser light usually don't hurt. Vision can deteriorate slowly and, therefore, may go unnoticed, for days and even weeks. Ultimately, the damage could be permanent, Hewett says.

Some examples of laser toys are:
lasers mounted on toy guns that can be used for “aiming”;spinning tops that project laser beams while they spin;hand-held lasers used during play as “light sabers”; andlasers intended for entertainment that create optical effects in an open room.

The FDA Regulates Lasers
A laser creates a powerful, targeted beam of electromagnetic radiation that is used in many products, from music players and printers to eye-surgery tools. The FDA regulates radiation-emitting electronic products, such as lasers (including children’s toy laser products), and sets radiation-safety standards that manufacturers must meet.

Toys with lasers are of particular interest to the FDA because children can be injured by these products. Because they are marketed as toys, parents and kids alike may believe they’re safe to use.

For toys to be considered minimal risk, the FDA recommends that the levels of radiation and light not exceed the limits for Class 1, the lowest level in regulated products as defined by the International Electrotechnical Commission (IEC).

Lasers used for industrial and other purposes often need higher radiation levels for their intended functions. But these higher levels are not needed for children’s toys—and if they are present, they can be dangerous.

Hand-held laser pointers—often used in business and higher education to help illustrate presentations—have increased in power 10-fold or more over the last decade. And while adults may buy a laser pointer for use in work, kids often play with them for amusement.

The fact that lasers can be dangerous may not be evident, particularly to the children who inappropriately use them as toys, or to the adults who supervise them.

Laser Safety: Tips to Keep in Mind
Remember that laser products are generally safe when they follow the legal limits and are used as directed. But lasers can cause harm if not used properly. The FDA recommends the following general safety tips for consumers.

Never aim or shine a laser directly at anyone, including animals. The light energy from a laser aimed into the eye can be hazardous, perhaps even more than staring directly into the sun.
Do not aim a laser at any vehicle, aircraft, or shiny surface. Remember that the startling effect of a bright beam of light can cause serious accidents when aimed at a driver in a car, for instance, or otherwise negatively affect someone doing another activity (such as playing sports).
Look for an FDA-recommended IEC Class I label on children’s toy lasers. The label says “Class 1 Laser Product,” which would clearly communicate that the product is of low risk and not in a higher emission level laser class.
Do not buy laser pointers for children, or allow children to use them. These products are not toys.
Do not buy or use any laser that emits more than 5mW power, or that does not have the power printed on the labeling.
Immediately consult a health care professional if you or a child suspects or experiences any eye injury.

You can watch the FDA’s video on laser pointer safety [disclaimer icon] for more information.

Many kids (and parents) who have seen Luke Skywalker battle Darth Vader with a light saber think lasers are cool.

What they may not know is this: When operated unsafely, or without certain controls, the highly-concentrated light from lasers—even those in toys—can be dangerous, causing serious eye injuries and even blindness. And not just to the person using a laser, but to anyone within range of the laser beam.

The U.S. Food and Drug Administration is concerned about this potential danger to children and those around them and in 2014 issued a guidance document (PDF 60K) on the safety of children’s toy laser products.

“A beam shone directly into a person’s eye can injure it in an instant, especially if the laser is a powerful one,” explains Dan Hewett, health promotion officer at the FDA’s Center for Devices and Radiological Health.

Moreover, eye injuries caused by laser light usually don't hurt. Vision can deteriorate slowly and, therefore, may go unnoticed, for days and even weeks. Ultimately, the damage could be permanent, Hewett says.

Some examples of laser toys are:

lasers mounted on toy guns that can be used for “aiming”;

spinning tops that project laser beams while they spin;

hand-held lasers used during play as “light sabers”; and

lasers intended for entertainment that create optical effects in an open room.

The FDA Regulates Lasers
A laser creates a powerful, targeted beam of electromagnetic radiation that is used in many products, from music players and printers to eye-surgery tools. The FDA regulates radiation-emitting electronic products, such as lasers (including children’s toy laser products), and sets radiation-safety standards that manufacturers must meet.

Toys with lasers are of particular interest to the FDA because children can be injured by these products. Because they are marketed as toys, parents and kids alike may believe they’re safe to use.

For toys to be considered minimal risk, the FDA recommends that the levels of radiation and light not exceed the limits for Class 1, the lowest level in regulated products as defined by the International Electrotechnical Commission (IEC).

Lasers used for industrial and other purposes often need higher radiation levels for their intended functions. But these higher levels are not needed for children’s toys—and if they are present, they can be dangerous.

Hand-held laser pointers—often used in business and higher education to help illustrate presentations—have increased in power 10-fold or more over the last decade. And while adults may buy a laser pointer for use in work, kids often play with them for amusement.

The fact that lasers can be dangerous may not be evident, particularly to the children who inappropriately use them as toys, or to the adults who supervise them.

Laser Safety: Tips to Keep in Mind
Remember that laser products are generally safe when they follow the legal limits and are used as directed. But lasers can cause harm if not used properly. The FDA recommends the following general safety tips for consumers.

Never aim or shine a laser directly at anyone, including animals. The light energy from a laser aimed into the eye can be hazardous, perhaps even more than staring directly into the sun.
Do not aim a laser at any vehicle, aircraft, or shiny surface. Remember that the startling effect of a bright beam of light can cause serious accidents when aimed at a driver in a car, for instance, or otherwise negatively affect someone doing another activity (such as playing sports).
Look for an FDA-recommended IEC Class I label on children’s toy lasers. The label says “Class 1 Laser Product,” which would clearly communicate that the product is of low risk and not in a higher emission level laser class.
Do not buy laser pointers for children, or allow children to use them. These products are not toys.
Do not buy or use any laser that emits more than 5mW power, or that does not have the power printed on the labeling.
Immediately consult a health care professional if you or a child suspects or experiences any eye injury.

You can watch the FDA’s video on laser pointer safety [disclaimer icon] for more information.

Most people have had an X-ray taken at some time during their lives — perhaps checking for a possible broken bone or during a visit to the dentist. X-ray exams provide important information to physicians about how to treat their patients. However, X-rays use ionizing radiation, and these imaging exams must be carefully and judiciously used on pediatric patients.

While the level of risk from the radiation associated with X-rays is small, especially when compared with the benefits of an accurate diagnosis, health care professionals must be especially sensitive to their appropriate use in children. Pediatric patients generally require less radiation than adults to obtain a quality image from an X-ray exam, so doctors must take extra care to “child size” the radiation dose.

FDA's Role

The FDA's Center for Devices and Radiological Health (CDRH) regulates medical imaging devices. Among its responsibilities is keeping consumers and health care professionals informed about the importance of minimizing unnecessary radiation exposure during medical procedures.

The level of ionizing radiation from X-ray imaging is generally very low, but can contribute to an increased risk of cancer. Because children have longer expected lifetimes ahead of them for potential effects to appear and the risk for cancer is not fully understood, it’s important to use the lowest radiation dose necessary to provide a diagnostic exam.

The FDA is committed to protecting the health of children by providing guidance to manufacturers and users of imaging devices to help lower the exposure to radiation from X-ray exams. The FDA has regulatory oversight of X-ray imaging devices and the companies that make them. To better address radiation safety concerns, the FDA has been encouraging both equipment improvements and better user information.

The FDA also promotes the adoption of improved radiation safety guidelines by professional organizations for both facilities and personnel.

Recommendations

In a new guidance FDA recommends that medical X-ray imaging exams be optimized to use the lowest radiation dose needed. These exams, which include computed tomography (CT), fluoroscopy, dental, and conventional X-rays, should be performed on children and younger patients only when the health care provider believes they are necessary to answer a clinical question or to guide treatment.

The FDA defines the pediatric population as birth through 21 years old. However, the optimization of image quality and radiation dose in X-ray imaging depends more on a patient’s size than their age. Smaller patients require less radiation to obtain a medically useful image. Technically, the patient’s body thickness (the distance an X-ray travels through the body to create the image) is the most important consideration when “child-sizing” an image protocol.

Unnecessary radiation exposure during medical procedures should be avoided. However, X-rays and CT scans should never be withheld from a child or adult who has a medical condition where the exam could provide important health care information that may aid in the diagnosis or treatment of a serious or even life-threatening illness.

What Parents Can Do

The FDA encourages parents and caregivers to talk to their child’s health care provider about X-rays and suggests:
Keeping track of their child's medical-imaging historiesAsking the referring physician about the benefits and risks of imaging procedures, such as: How will the exam improve my child's health care Are there alternative exams to X-rays that are equally usefulAsking the imaging facility: How does the facility use reduced radiation techniques for children Is there any advanced preparation necessary Report any adverse events to the FDA.

The Role of Health Care Professionals

Health care professionals are responsible for ensuring there is justification for all X-ray imaging exams performed on pediatric patients. They should also consider whether another type of imaging exam that does not expose the patient to ionizing radiation, such as ultrasound or magnetic resonance imaging, could be used to obtain the same result.

Most people have had an X-ray taken at some time during their lives — perhaps checking for a possible broken bone or during a visit to the dentist. X-ray exams provide important information to physicians about how to treat their patients. However, X-rays use ionizing radiation, and these imaging exams must be carefully and judiciously used on pediatric patients.

While the level of risk from the radiation associated with X-rays is small, especially when compared with the benefits of an accurate diagnosis, health care professionals must be especially sensitive to their appropriate use in children. Pediatric patients generally require less radiation than adults to obtain a quality image from an X-ray exam, so doctors must take extra care to “child size” the radiation dose.

FDA's Role

The FDA's Center for Devices and Radiological Health (CDRH) regulates medical imaging devices. Among its responsibilities is keeping consumers and health care professionals informed about the importance of minimizing unnecessary radiation exposure during medical procedures.

The level of ionizing radiation from X-ray imaging is generally very low, but can contribute to an increased risk of cancer. Because children have longer expected lifetimes ahead of them for potential effects to appear and the risk for cancer is not fully understood, it’s important to use the lowest radiation dose necessary to provide a diagnostic exam.

The FDA is committed to protecting the health of children by providing guidance to manufacturers and users of imaging devices to help lower the exposure to radiation from X-ray exams. The FDA has regulatory oversight of X-ray imaging devices and the companies that make them. To better address radiation safety concerns, the FDA has been encouraging both equipment improvements and better user information.

The FDA also promotes the adoption of improved radiation safety guidelines by professional organizations for both facilities and personnel.

Recommendations

In a new guidance FDA recommends that medical X-ray imaging exams be optimized to use the lowest radiation dose needed. These exams, which include computed tomography (CT), fluoroscopy, dental, and conventional X-rays, should be performed on children and younger patients only when the health care provider believes they are necessary to answer a clinical question or to guide treatment.

The FDA defines the pediatric population as birth through 21 years old. However, the optimization of image quality and radiation dose in X-ray imaging depends more on a patient’s size than their age. Smaller patients require less radiation to obtain a medically useful image. Technically, the patient’s body thickness (the distance an X-ray travels through the body to create the image) is the most important consideration when “child-sizing” an image protocol.

Unnecessary radiation exposure during medical procedures should be avoided. However, X-rays and CT scans should never be withheld from a child or adult who has a medical condition where the exam could provide important health care information that may aid in the diagnosis or treatment of a serious or even life-threatening illness.

What Parents Can Do

The FDA encourages parents and caregivers to talk to their child’s health care provider about X-rays and suggests:

Keeping track of their child's medical-imaging histories

Asking the referring physician about the benefits and risks of imaging procedures, such as: How will the exam improve my child's health care Are there alternative exams to X-rays that are equally useful

Asking the imaging facility: How does the facility use reduced radiation techniques for children Is there any advanced preparation necessary Report any adverse events to the FDA.

The Role of Health Care Professionals

Health care professionals are responsible for ensuring there is justification for all X-ray imaging exams performed on pediatric patients. They should also consider whether another type of imaging exam that does not expose the patient to ionizing radiation, such as ultrasound or magnetic resonance imaging, could be used to obtain the same result.

Dietary supplementation is approximately a $30 billion industry in the United States, with more than 90 000 products on the market. In recent national surveys, 52% of US adults reported use of at least 1 supplement product, and 10% reported use of at least 4 such products.1 Vitamins and minerals are among the most popular supplements and are taken by 48% and 39% of adults, respectively, typically to maintain health and prevent disease.

Despite this enthusiasm, most randomized clinical trials of vitamin and mineral supplements have not demonstrated clear benefits for primary or secondary prevention of chronic diseases not related to nutritional deficiency. Indeed, some trials suggest that micronutrient supplementation in amounts that exceed the recommended dietary allowance (RDA)—eg, high doses of beta carotene, folic acid, vitamin E, or selenium—may have harmful effects, including increased mortality, cancer, and hemorrhagic stroke.

In this Viewpoint, we provide information to help clinicians address frequently asked questions about micronutrient supplements from patients, as well as promote appropriate use and curb inappropriate use of such supplements among generally healthy individuals. Importantly, clinicians should counsel their patients that such supplementation is not a substitute for a healthful and balanced diet and, in most cases, provides little if any benefit beyond that conferred by such a diet.

Clinicians should also highlight the many advantages of obtaining vitamins and minerals from food instead of from supplements. Micronutrients in food are typically better absorbed by the body and are associated with fewer potential adverse effects. A healthful diet provides an array of nutritionally important substances in biologically optimal ratios as opposed to isolated compounds in highly concentrated form. Indeed, research shows that positive health outcomes are more strongly related to dietary patterns and specific food types than to individual micronutrient or nutrient intakes.

Although routine micronutrient supplementation is not recommended for the general population, targeted supplementation may be warranted in high-risk groups for whom nutritional requirements may not be met through diet alone, including people at certain life stages and those with specific risk factors (discussed in the next 3 sections and in the Box).

Box.Key Points on Vitamin and Mineral Supplements
General Guidance for Supplementation in a Healthy Population by Life Stage

Pregnancy: folic acid, prenatal vitamins

Infants and children: for breastfed infants, vitamin D until weaning and iron from age 4-6 mo

Pregnancy
The evidence is clear that women who may become pregnant or who are in the first trimester of pregnancy should be advised to consume adequate folic acid (0.4-0.8 mg/d) to prevent neural tube defects. Folic acid is one of the few micronutrients more bioavailable in synthetic form from supplements or fortified foods than in the naturally occurring dietary form (folate). Prenatal multivitamin/multimineral supplements will provide folic acid as well as vitamin D and many other essential micronutrients during pregnancy. Pregnant women should also be advised to eat an iron-rich diet. Although it may also be prudent to prescribe supplemental iron for pregnant women with low levels of hemoglobin or ferritin to prevent and treat iron-deficiency anemia, the benefit-risk balance of screening for anemia and routine iron supplementation during pregnancy is not well characterized.

Supplemental calcium may reduce the risk of gestational hypertension and preeclampsia, but confirmatory large trials are needed.2 Use of high-dose vitamin D supplements during pregnancy also warrants further study.2 The American College of Obstetricians and Gynecologists has developed a useful patient handout on micronutrient nutrition during pregnancy.

Infants and Children
The American Academy of Pediatrics recommends that exclusively or partially breastfed infants receive (1) supplemental vitamin D (400 IU/d) starting soon after birth and continuing until weaning to vitamin D–fortified whole milk (≥1 L/d) and (2) supplemental iron (1 mg/kg/d) from 4 months until the introduction of iron-containing foods, usually at 6 months.5 Infants who receive formula, which is fortified with vitamin D and (often) iron, do not typically require additional supplementation. All children should be screened at 1 year for iron deficiency and iron-deficiency anemia.

Healthy children consuming a well-balanced diet do not need multivitamin/multimineral supplements, and they should avoid those containing micronutrient doses that exceed the RDA. In recent years, ω-3 fatty acid supplementation has been viewed as a potential strategy for reducing the risk of autism spectrum disorder or attention-deficit/hyperactivity disorder in children, but evidence from large randomized trials is lacking.

Midlife and Older Adults
With respect to vitamin B12, adults aged 50 years and older may not adequately absorb the naturally occurring, protein-bound form of this nutrient and thus should be advised to meet the RDA (2.4 μg/d) with synthetic B12 found in fortified foods or supplements.6 Patients with pernicious anemia will require higher doses (Box).

Regarding vitamin D, currently recommended intakes (from food or supplements) to maintain bone health are 600 IU/d for adults up to age 70 years and 800 IU/d for those aged older than 70 years. Some professional organizations recommend 1000 to 2000 IU/d, but it has been widely debated whether doses above the RDA offer additional benefits. Ongoing large-scale randomized trials (NCT01169259 and ACTRN12613000743763) should help to resolve continuing uncertainties soon.

With respect to calcium, current RDAs are 1000 mg/d for men aged 51 to 70 years and 1200 mg/d for women aged 51 to 70 years and for all adults aged older than 70 years. Given recent concerns that calcium supplements may increase the risk for kidney stones and possibly cardiovascular disease, patients should aim to meet this recommendation primarily by eating a calcium-rich diet and take calcium supplements only if needed to reach the RDA goal (often only about 500 mg/d in supplements is required).2 A recent meta-analysis suggested that supplementation with moderate-dose calcium (<1000 mg/d) plus vitamin D (≥800 IU/d) might reduce the risk of fractures and loss of bone mass density among postmenopausal women and men aged 65 years and older.

Multivitamin/multimineral supplementation is not recommended for generally healthy adults.8 One large trial in US men found a modest lowering of cancer risk,9 but the results require replication in large trials that include women and allow for analysis by baseline nutrient status, a potentially important modifier of the treatment effect. An ongoing large-scale 4-year trial (NCT02422745) is expected to clarify the benefit-risk balance of multivitamin/multimineral supplements taken for primary prevention of cancer and cardiovascular disease.

Other Key Points
When reviewing medications with patients, clinicians should ask about use of micronutrient (and botanical or other dietary) supplements in counseling about potential interactions. For example, supplemental vitamin K can decrease the effectiveness of warfarin, and biotin (vitamin B7) can interfere with the accuracy of cardiac troponin and other laboratory tests. Patient-friendly interaction checkers are available free of charge online (search for interaction checkers on drugs.com, WebMD, or pharmacy websites).

Clinicians and patients should also be aware that the US Food and Drug Administration is not authorized to review dietary supplements for safety and efficacy prior to marketing. Although supplement makers are required to adhere to the agency’s Good Manufacturing Practice regulations, compliance monitoring is less than optimal. Thus, clinicians may wish to favor prescription products, when available, or advise patients to consider selecting a supplement that has been certified by independent testers (ConsumerLab.com, US Pharmacopeia, NSF International, or UL) to contain the labeled dose(s) of the active ingredient(s) and not to contain microbes, heavy metals, or other toxins. Clinicians (or patients) should report suspected supplement-related adverse effects to the Food and Drug Administration via MedWatch, the online safety reporting portal. An excellent source of information on micronutrient and other dietary supplements for both clinicians and patients is the website of the Office of Dietary Supplements of the National Institutes of Health.

Clinicians have an opportunity to promote appropriate use and to curb inappropriate use of micronutrient supplements, and these efforts are likely to improve public health.

Dietary supplementation is approximately a $30 billion industry in the United States, with more than 90 000 products on the market. In recent national surveys, 52% of US adults reported use of at least 1 supplement product, and 10% reported use of at least 4 such products.1 Vitamins and minerals are among the most popular supplements and are taken by 48% and 39% of adults, respectively, typically to maintain health and prevent disease.

Despite this enthusiasm, most randomized clinical trials of vitamin and mineral supplements have not demonstrated clear benefits for primary or secondary prevention of chronic diseases not related to nutritional deficiency. Indeed, some trials suggest that micronutrient supplementation in amounts that exceed the recommended dietary allowance (RDA)—eg, high doses of beta carotene, folic acid, vitamin E, or selenium—may have harmful effects, including increased mortality, cancer, and hemorrhagic stroke.

In this Viewpoint, we provide information to help clinicians address frequently asked questions about micronutrient supplements from patients, as well as promote appropriate use and curb inappropriate use of such supplements among generally healthy individuals. Importantly, clinicians should counsel their patients that such supplementation is not a substitute for a healthful and balanced diet and, in most cases, provides little if any benefit beyond that conferred by such a diet.

Clinicians should also highlight the many advantages of obtaining vitamins and minerals from food instead of from supplements. Micronutrients in food are typically better absorbed by the body and are associated with fewer potential adverse effects. A healthful diet provides an array of nutritionally important substances in biologically optimal ratios as opposed to isolated compounds in highly concentrated form. Indeed, research shows that positive health outcomes are more strongly related to dietary patterns and specific food types than to individual micronutrient or nutrient intakes.

Although routine micronutrient supplementation is not recommended for the general population, targeted supplementation may be warranted in high-risk groups for whom nutritional requirements may not be met through diet alone, including people at certain life stages and those with specific risk factors (discussed in the next 3 sections and in the Box).

Box.Key Points on Vitamin and Mineral Supplements
General Guidance for Supplementation in a Healthy Population by Life Stage

Pregnancy: folic acid, prenatal vitamins

Infants and children: for breastfed infants, vitamin D until weaning and iron from age 4-6 mo

Pregnancy
The evidence is clear that women who may become pregnant or who are in the first trimester of pregnancy should be advised to consume adequate folic acid (0.4-0.8 mg/d) to prevent neural tube defects. Folic acid is one of the few micronutrients more bioavailable in synthetic form from supplements or fortified foods than in the naturally occurring dietary form (folate). Prenatal multivitamin/multimineral supplements will provide folic acid as well as vitamin D and many other essential micronutrients during pregnancy. Pregnant women should also be advised to eat an iron-rich diet. Although it may also be prudent to prescribe supplemental iron for pregnant women with low levels of hemoglobin or ferritin to prevent and treat iron-deficiency anemia, the benefit-risk balance of screening for anemia and routine iron supplementation during pregnancy is not well characterized.

Supplemental calcium may reduce the risk of gestational hypertension and preeclampsia, but confirmatory large trials are needed.2 Use of high-dose vitamin D supplements during pregnancy also warrants further study.2 The American College of Obstetricians and Gynecologists has developed a useful patient handout on micronutrient nutrition during pregnancy.

Infants and Children
The American Academy of Pediatrics recommends that exclusively or partially breastfed infants receive (1) supplemental vitamin D (400 IU/d) starting soon after birth and continuing until weaning to vitamin D–fortified whole milk (≥1 L/d) and (2) supplemental iron (1 mg/kg/d) from 4 months until the introduction of iron-containing foods, usually at 6 months.5 Infants who receive formula, which is fortified with vitamin D and (often) iron, do not typically require additional supplementation. All children should be screened at 1 year for iron deficiency and iron-deficiency anemia.

Healthy children consuming a well-balanced diet do not need multivitamin/multimineral supplements, and they should avoid those containing micronutrient doses that exceed the RDA. In recent years, ω-3 fatty acid supplementation has been viewed as a potential strategy for reducing the risk of autism spectrum disorder or attention-deficit/hyperactivity disorder in children, but evidence from large randomized trials is lacking.

Midlife and Older Adults
With respect to vitamin B12, adults aged 50 years and older may not adequately absorb the naturally occurring, protein-bound form of this nutrient and thus should be advised to meet the RDA (2.4 μg/d) with synthetic B12 found in fortified foods or supplements.6 Patients with pernicious anemia will require higher doses (Box).

Regarding vitamin D, currently recommended intakes (from food or supplements) to maintain bone health are 600 IU/d for adults up to age 70 years and 800 IU/d for those aged older than 70 years. Some professional organizations recommend 1000 to 2000 IU/d, but it has been widely debated whether doses above the RDA offer additional benefits. Ongoing large-scale randomized trials (NCT01169259 and ACTRN12613000743763) should help to resolve continuing uncertainties soon.

With respect to calcium, current RDAs are 1000 mg/d for men aged 51 to 70 years and 1200 mg/d for women aged 51 to 70 years and for all adults aged older than 70 years. Given recent concerns that calcium supplements may increase the risk for kidney stones and possibly cardiovascular disease, patients should aim to meet this recommendation primarily by eating a calcium-rich diet and take calcium supplements only if needed to reach the RDA goal (often only about 500 mg/d in supplements is required).2 A recent meta-analysis suggested that supplementation with moderate-dose calcium (<1000 mg/d) plus vitamin D (≥800 IU/d) might reduce the risk of fractures and loss of bone mass density among postmenopausal women and men aged 65 years and older.

Multivitamin/multimineral supplementation is not recommended for generally healthy adults.8 One large trial in US men found a modest lowering of cancer risk,9 but the results require replication in large trials that include women and allow for analysis by baseline nutrient status, a potentially important modifier of the treatment effect. An ongoing large-scale 4-year trial (NCT02422745) is expected to clarify the benefit-risk balance of multivitamin/multimineral supplements taken for primary prevention of cancer and cardiovascular disease.

Other Key Points
When reviewing medications with patients, clinicians should ask about use of micronutrient (and botanical or other dietary) supplements in counseling about potential interactions. For example, supplemental vitamin K can decrease the effectiveness of warfarin, and biotin (vitamin B7) can interfere with the accuracy of cardiac troponin and other laboratory tests. Patient-friendly interaction checkers are available free of charge online (search for interaction checkers on drugs.com, WebMD, or pharmacy websites).

Clinicians and patients should also be aware that the US Food and Drug Administration is not authorized to review dietary supplements for safety and efficacy prior to marketing. Although supplement makers are required to adhere to the agency’s Good Manufacturing Practice regulations, compliance monitoring is less than optimal. Thus, clinicians may wish to favor prescription products, when available, or advise patients to consider selecting a supplement that has been certified by independent testers (ConsumerLab.com, US Pharmacopeia, NSF International, or UL) to contain the labeled dose(s) of the active ingredient(s) and not to contain microbes, heavy metals, or other toxins. Clinicians (or patients) should report suspected supplement-related adverse effects to the Food and Drug Administration via MedWatch, the online safety reporting portal. An excellent source of information on micronutrient and other dietary supplements for both clinicians and patients is the website of the Office of Dietary Supplements of the National Institutes of Health.

Clinicians have an opportunity to promote appropriate use and to curb inappropriate use of micronutrient supplements, and these efforts are likely to improve public health.

Enjoy a safe and happy Halloween by following these guidelines from FDA, the Consumer Product Safety Commission, and the Centers for Disease Control and Prevention:
Wear costumes that say “flame resistant” on the label. If you make your costume, use flame-resistant fabrics such as polyester or nylon.Wear bright, reflective costumes or add strips of reflective tape so you’ll be more visible; make sure the costumes aren’t so long that you’re in danger of tripping.Wear makeup and hats rather than masks that can obscure your vision.Test the makeup you plan to use in advance. Put a small amount on the arm of the person who will be wearing it. If a rash, redness, swelling, or other signs of irritation develop where the makeup was applied, that's a sign of a possible allergy.Vibrantly colored makeup is popular at Halloween. Check FDA’s list of color additives to see if the colors are FDA approved. If they aren’t approved for their intended use, don’t use them. This is especially important for colored makeup around the eyes.Don’t wear decorative (colored) contact lenses unless you have seen an eye care professional for a proper fitting and been given instructions for how to use the lenses.

Safe Treats

Eating sweet treats is also a big part of Halloween fun.
Before you or your children go trick-or-treating, remember these tips:
•Don’t eat candy until it has been inspected at home.
•Eat a snack before heading out to avoid the temptation of nibbling on a treat before it has been inspected.
•In case of a food allergy, check the label to ensure the allergen isn’t present. Tell children not to accept—or eat—anything that isn’t commercially wrapped.
•Parents of very young children should remove any choking hazards such as gum, peanuts, hard candies, or small toys from the Halloween bags.
•Inspect commercially wrapped treats for signs of tampering, such as an unusual appearance or discoloration, tiny pinholes, or tears in wrappers. Throw away anything that looks suspicious.

For partygoers and party throwers, FDA recommends the following tips for two seasonal favorites:

•Unpasteurized juices and juices that have not been further processed are at higher risk of food- borne illness. Look for the warning label to identify juice that hasn’t been pasteurized or otherwise processed, especially packaged juice products made on site. If unsure, always ask if juice has been pasteurized or not. Normally, juice in boxes, bottles or cans from your grocer’s frozen food case, refrigerated section, or shelf has been pasteurized.

•Before bobbing for apples—a favorite Halloween game—reduce the risk of bacteria by thoroughly rinsing the apples under cool running water. As an added precaution, use a produce brush to remove surface dirt.

Eye Safety

FDA joins eye care professionals—including the American Academy of Ophthalmology, the American Association for Pediatric Ophthalmology and Strabismus, the Contact Lens Association of Ophthalmologists and the American Optometric Association—in discouraging consumers from using illegal decorative (colored) contact lenses. These are contact lenses that have not been approved by FDA for safety and effectiveness. Consumers should only use brand name contact lenses from well-known contact lens companies.

If you have never worn contact lenses before, Halloween should not be the first time you wear them. Experts warn that buying any kind of contact lenses—which are medical devices and regulated as such—without an examination and a prescription from an eye care professional can cause serious eye disorders and infections, which may lead to permanent vision loss. Despite the fact that it’s illegal to sell decorative contact lenses without a valid prescription, FDA says the lenses are sold on the Internet and in retail shops and salons—particularly around Halloween.

The decorative lenses make the wearer’s eyes appear to glow in the dark, create the illusion of vertical “cat eyes,” or change the wearer’s eye color.

Although unauthorized use of decorative contact lenses is a concern year-round, Halloween is the time when people may be inclined to use them, perhaps as costume accessories. When they are bought and used without a valid prescription, without the involvement of a qualified eye care professional, or without appropriate follow-up care, it can lead to significant risks of eye injuries, including blindness.

Enjoy a safe and happy Halloween by following these guidelines from FDA, the Consumer Product Safety Commission, and the Centers for Disease Control and Prevention:

Wear costumes that say “flame resistant” on the label. If you make your costume, use flame-resistant fabrics such as polyester or nylon.

Wear bright, reflective costumes or add strips of reflective tape so you’ll be more visible; make sure the costumes aren’t so long that you’re in danger of tripping.

Wear makeup and hats rather than masks that can obscure your vision.

Test the makeup you plan to use in advance. Put a small amount on the arm of the person who will be wearing it. If a rash, redness, swelling, or other signs of irritation develop where the makeup was applied, that's a sign of a possible allergy.

Vibrantly colored makeup is popular at Halloween. Check FDA’s list of color additives to see if the colors are FDA approved. If they aren’t approved for their intended use, don’t use them. This is especially important for colored makeup around the eyes.

Don’t wear decorative (colored) contact lenses unless you have seen an eye care professional for a proper fitting and been given instructions for how to use the lenses.

Safe Treats

Eating sweet treats is also a big part of Halloween fun.
Before you or your children go trick-or-treating, remember these tips:
•Don’t eat candy until it has been inspected at home.
•Eat a snack before heading out to avoid the temptation of nibbling on a treat before it has been inspected.
•In case of a food allergy, check the label to ensure the allergen isn’t present. Tell children not to accept—or eat—anything that isn’t commercially wrapped.
•Parents of very young children should remove any choking hazards such as gum, peanuts, hard candies, or small toys from the Halloween bags.
•Inspect commercially wrapped treats for signs of tampering, such as an unusual appearance or discoloration, tiny pinholes, or tears in wrappers. Throw away anything that looks suspicious.

For partygoers and party throwers, FDA recommends the following tips for two seasonal favorites:

•Unpasteurized juices and juices that have not been further processed are at higher risk of food- borne illness. Look for the warning label to identify juice that hasn’t been pasteurized or otherwise processed, especially packaged juice products made on site. If unsure, always ask if juice has been pasteurized or not. Normally, juice in boxes, bottles or cans from your grocer’s frozen food case, refrigerated section, or shelf has been pasteurized.

•Before bobbing for apples—a favorite Halloween game—reduce the risk of bacteria by thoroughly rinsing the apples under cool running water. As an added precaution, use a produce brush to remove surface dirt.

Eye Safety

FDA joins eye care professionals—including the American Academy of Ophthalmology, the American Association for Pediatric Ophthalmology and Strabismus, the Contact Lens Association of Ophthalmologists and the American Optometric Association—in discouraging consumers from using illegal decorative (colored) contact lenses. These are contact lenses that have not been approved by FDA for safety and effectiveness. Consumers should only use brand name contact lenses from well-known contact lens companies.

If you have never worn contact lenses before, Halloween should not be the first time you wear them. Experts warn that buying any kind of contact lenses—which are medical devices and regulated as such—without an examination and a prescription from an eye care professional can cause serious eye disorders and infections, which may lead to permanent vision loss. Despite the fact that it’s illegal to sell decorative contact lenses without a valid prescription, FDA says the lenses are sold on the Internet and in retail shops and salons—particularly around Halloween.

The decorative lenses make the wearer’s eyes appear to glow in the dark, create the illusion of vertical “cat eyes,” or change the wearer’s eye color.

Although unauthorized use of decorative contact lenses is a concern year-round, Halloween is the time when people may be inclined to use them, perhaps as costume accessories. When they are bought and used without a valid prescription, without the involvement of a qualified eye care professional, or without appropriate follow-up care, it can lead to significant risks of eye injuries, including blindness.

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Have you told someone about being bullied and nothing has changed? Don’t give up! Did you know that you have the legal right to be safe at school? If the bullying continues even after you told an adult, know that there are laws designed to protect you (find your state law or policy at StopBullying.gov). It is very important for students to reach out to another trusted adult and ask for help again. This adult can be a parent, a teacher, a coach, or anyone from the community. Let them know that you need their help and that you wouldn’t be coming to them if you could fix the situation on your own.

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If you told an adult about a bullying situation and it wasn’t helpful, don’t give up! Be a self-advocate. Speak up for yourself and let another adult know what you need in order to feel safe. Every student has the right to feel safe at school.

All states have laws or policies to address bullying prevention in schools. Some adults may not be aware of these laws or realize that the school has a bullying prevention policy in place. Share your knowledge that there is a law, and keep talking until someone understands and gives you support. There are people who care and will help you.

When speaking to a trusted adult, whether it be a school administrator, a teacher, counselor, or another adult in the community, share important information with them, such as:
a description of the bullyinga reminder that there are laws outlining the school’s responsibility in handling bullying situationsa discussion of the school’s bullying prevention policy

You may have additional protections when the bullying is about race, color, national origin, age, sex, religion, or disability. This is called harassment and there is a federal law.

On your own, or with the help of an adult, create an action plan. Write down what is happening to you with details about where it happens and who is involved. Think about what you can do to change your situation or what would help you gain control over the situation. PACER’s Student Action Plan can be a great place to start this process.

Bullying hurts, it’s emotional, but know that you do not have to deal with it alone. The first person may not have been able to help, but keep going. There are adults who will listen, be there for you, and support you.

Blog
Read the article written by PACER staff, which was posted to Disney’s Babble blog: Speaking up about bullying isn’t tattling and our kids need to know the difference.

浓缩版
Have you told someone about being bullied and nothing has changed? Don’t give up! Did you know that you have the legal right to be safe at school? If the bullying continues even after you told an adult, know that there are laws designed to protect you (find your state law or policy at StopBullying.gov). It is very important for students to reach out to another trusted adult and ask for help again. This adult can be a parent, a teacher, a coach, or anyone from the community. Let them know that you need their help and that you wouldn’t be coming to them if you could fix the situation on your own.

完整版

If you told an adult about a bullying situation and it wasn’t helpful, don’t give up! Be a self-advocate. Speak up for yourself and let another adult know what you need in order to feel safe. Every student has the right to feel safe at school.

All states have laws or policies to address bullying prevention in schools. Some adults may not be aware of these laws or realize that the school has a bullying prevention policy in place. Share your knowledge that there is a law, and keep talking until someone understands and gives you support. There are people who care and will help you.

When speaking to a trusted adult, whether it be a school administrator, a teacher, counselor, or another adult in the community, share important information with them, such as:

a description of the bullying

a reminder that there are laws outlining the school’s responsibility in handling bullying situations

a discussion of the school’s bullying prevention policy

You may have additional protections when the bullying is about race, color, national origin, age, sex, religion, or disability. This is called harassment and there is a federal law.

On your own, or with the help of an adult, create an action plan. Write down what is happening to you with details about where it happens and who is involved. Think about what you can do to change your situation or what would help you gain control over the situation. PACER’s Student Action Plan can be a great place to start this process.

Bullying hurts, it’s emotional, but know that you do not have to deal with it alone. The first person may not have been able to help, but keep going. There are adults who will listen, be there for you, and support you.

Blog
Read the article written by PACER staff, which was posted to Disney’s Babble blog: Speaking up about bullying isn’t tattling and our kids need to know the difference.

浓缩版
When your child is the target of bullying, a parent’s first response is often an emotional one, followed by a sense of wanting to know the most effective, action-oriented response. Building positive relationships between the school, parents, and students will ensure that a plan and timeline of action can be quickly set in place to prevent further bullying.

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It can be heartbreaking for parents to learn that their child is being bullied at school. It is difficult for parents to know what to do when a report of bullying is made, and if they should have done something ahead of time that might have influenced what happened to their child. Developing positive relationships with teachers and staff, while using effective communication tools, can help greatly when dealing with a difficult situation such as bullying.

Staff are often the first adults to learn about a school bullying situation, and they can identify different patterns and social patterns with students than parents do at home. Partnerships between parents and school personnel is one of the best ways to prevent further bullying and is essential when bullying is happening at school.

Here are some best practices to guide parents working with school staff toward a healthier and safer school environment for their child:

Speak with an adult at school who knows your child well
Do establish a relationship with your child’s teachers at the beginning of the school year.Do immediately contact a teacher or another staff member (such as the principal or an advisor) who is close to your child if there is a report of bullying.Do understand that they may redirect you to the appropriate person. In some schools this is the dean of students; in other schools, it might be the vice principal who is responsible for bullying and discipline issues. The information on who to contact and how the process will be addressed should be available on your school’s website, from school administration, or in your parent handbook.

Keeping records and written information
Do document and create a timeline for what your child has told you with dates, times, and people involved in the bullying.Do note who you speak to at the school.Do ask about the timing of the follow-up process and who will be getting back to you.Do create a paper file that will hold hard copies of everything.Do keep documentation in that file of all communication with the school, including emails, calls, and letters.Do keep a history of any bullying behavior, documenting face-to-face incidents, or the screenshots, texts, or URLs of bullying directed at your child.

Meeting with school staff
Do bring your file with you, and prepare questions and a list of priorities and concerns to discuss. Know that it’s possible you will feel stressed; try to stay calm and communicate what your child needs as clearly as possible. Ask in advance what the purpose of the meeting will be and who will be there.Do make sure that there is an agenda and that your items are on it.Do repeat what you’ve heard so that you can be sure of what school staff are saying.Do summarize the outcomes at the end of the meeting.Do determine who will be responsible for future steps.Do offer thanks for what staff have done so far and what will happen in the future for your child.

Asking questions
Do ask what, who, when, where, and how questions.Do follow up with constructive phrases such as:

“Tell me more about…”“Please explain…”“What do you suggest we do about…”“I think I heard you say… is that correct”

Creating a plan
Do describe the problem clearly while encouraging input from all members of the team.Do allow for brainstorming without evaluating the ideas.Do participate in the brainstorming as an advocate for your child’s needs.Do ask your child for their feedback and ideas on what they’d like to see happen.Do choose a solution by consensus (all parties in agreement). Define who is responsible for an action and when it will be done.Do put that plan in writing, and create a timeline and criteria to evaluate success.Do understand that participation and follow up will be needed from everyone.

While bullying is a difficult situation for everyone involved, a good partnership between the school and parents can help address the situation and prevent further bullying. Using the best practices of good communication strategies and planning, parents can collaborate with the school to ensure a good outcome for their child, whatever the problem.

More details can be found at the interactive online module PACER.org/bullying/resources/parents/working-with-school.asp.

浓缩版
When your child is the target of bullying, a parent’s first response is often an emotional one, followed by a sense of wanting to know the most effective, action-oriented response. Building positive relationships between the school, parents, and students will ensure that a plan and timeline of action can be quickly set in place to prevent further bullying.

完整版

It can be heartbreaking for parents to learn that their child is being bullied at school. It is difficult for parents to know what to do when a report of bullying is made, and if they should have done something ahead of time that might have influenced what happened to their child. Developing positive relationships with teachers and staff, while using effective communication tools, can help greatly when dealing with a difficult situation such as bullying.

Staff are often the first adults to learn about a school bullying situation, and they can identify different patterns and social patterns with students than parents do at home. Partnerships between parents and school personnel is one of the best ways to prevent further bullying and is essential when bullying is happening at school.

Here are some best practices to guide parents working with school staff toward a healthier and safer school environment for their child:

Speak with an adult at school who knows your child well

Do establish a relationship with your child’s teachers at the beginning of the school year.

Do immediately contact a teacher or another staff member (such as the principal or an advisor) who is close to your child if there is a report of bullying.

Do understand that they may redirect you to the appropriate person. In some schools this is the dean of students; in other schools, it might be the vice principal who is responsible for bullying and discipline issues. The information on who to contact and how the process will be addressed should be available on your school’s website, from school administration, or in your parent handbook.

Keeping records and written information

Do document and create a timeline for what your child has told you with dates, times, and people involved in the bullying.

Do note who you speak to at the school.

Do ask about the timing of the follow-up process and who will be getting back to you.

Do create a paper file that will hold hard copies of everything.

Do keep documentation in that file of all communication with the school, including emails, calls, and letters.

Do keep a history of any bullying behavior, documenting face-to-face incidents, or the screenshots, texts, or URLs of bullying directed at your child.

Meeting with school staff

Do bring your file with you, and prepare questions and a list of priorities and concerns to discuss. Know that it’s possible you will feel stressed; try to stay calm and communicate what your child needs as clearly as possible. Ask in advance what the purpose of the meeting will be and who will be there.

Do make sure that there is an agenda and that your items are on it.

Do repeat what you’ve heard so that you can be sure of what school staff are saying.

Do summarize the outcomes at the end of the meeting.

Do determine who will be responsible for future steps.

Do offer thanks for what staff have done so far and what will happen in the future for your child.

Asking questions

Do ask what, who, when, where, and how questions.

Do follow up with constructive phrases such as:

“Tell me more about…”

“Please explain…”

“What do you suggest we do about…”

“I think I heard you say… is that correct”

Creating a plan

Do describe the problem clearly while encouraging input from all members of the team.

Do allow for brainstorming without evaluating the ideas.

Do participate in the brainstorming as an advocate for your child’s needs.

Do ask your child for their feedback and ideas on what they’d like to see happen.

Do choose a solution by consensus (all parties in agreement). Define who is responsible for an action and when it will be done.

Do put that plan in writing, and create a timeline and criteria to evaluate success.

Do understand that participation and follow up will be needed from everyone.

While bullying is a difficult situation for everyone involved, a good partnership between the school and parents can help address the situation and prevent further bullying. Using the best practices of good communication strategies and planning, parents can collaborate with the school to ensure a good outcome for their child, whatever the problem.

More details can be found at the interactive online module PACER.org/bullying/resources/parents/working-with-school.asp.

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When a child is bullying others, it’s important that parents and educators take action. It is equally important for adults to recognize that bullying is about behavior, and they should choose responses that acknowledge behavior can be changed. Reframing the focus from labeling a child as a “bully” to referring to them as a “child with bullying behavior” recognizes that there is capacity for change. While children who are bullying others should be given appropriate consequences for their behavior, adults should be talking with their children to learn why they are bullying others. Children need to understand the impact their behavior has on others and realize the hurt they are causing. With adult guidance, redirecting bullying behavior toward an understanding of differences, as well as the practices of kindness and inclusion, are good strategies for reshaping a child’s behavior.

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Bullying is a learned behavior — and it can be “unlearned” and replaced with more positive behaviors. By talking with your child and taking action, you can teach your child more appropriate ways of handling feelings and responding to peer pressure and conflicts.

While it is important to look into any report of bullying and have it stopped quickly, it is good to remember that children are still developing an awareness of the skills they need to maintain healthy relationships. Their behavior can and does change throughout childhood as their identity is formed.

Finding strategies to assist with the development of positive behaviors can influence bullying behavior in children, at home, or at school. If you suspect or know that your child has been bullying others, here are some things to do right away and on an ongoing basis:
Talk with your child. Children may not always recognize their behavior as bullying. They may see it as “just having fun” and not realize the impact it has on another child. Help them understand what defines bullying and emphasize that this behavior is never appropriate.Explore reasons for the behavior. Find out why your child is behaving in a manner that is harmful to others through an open, nonjudgmental discussion. Here are some helpful tips on having that conversation.Confirm that your child’s behavior is bullying and not the result of a disability. Sometimes, children with disabilities who have certain emotional and behavioral disorders, or are in the process of developing social skills, may act in ways that are mistaken for bullying.Develop an action plan. It’s important to think through the steps that work for you, your child, and your situation. A good tool to use is this Student Action Plan.Teach empathy, respect, and compassion. Children who bully often lack awareness of how others feel or understand how their actions impact someone else. Try to understand your child’s feelings and help your child appreciate how others feel when they are bullied. Let your child know that everyone has feelings and that feelings matter.Make your expectations clear. Let your child know that bullying is not okay under any circumstances and that you will not tolerate it. Let them know that there will be consequences for their behavior. Take immediate action if you learn that he or she is involved in a bullying incident.Provide clear and consistent consequences for bullying. Be specific about what will happen if the bullying continues. Try to find meaningful consequences that fit the situation, such as loss of privileges or activities. If the behavior does not change, consider increasing the significance of the consequences.Teach by example. Help your child learn different ways to resolve conflict and deal with feelings, such as anger, insecurity, or frustration. Teach and reward appropriate behavior.Provide positive feedback. When your child handles conflict well, shows compassion for others, or find a positive way to deal with feelings, provide praise and recognition. Positive reinforcement can help improve behavior and is usually more effective than punishment.Be realistic. It takes time to change behavior. Recognize that there may be setbacks. Be patient as your child learns new ways of handling feelings and conflict. Keep your concern and support visible.

Speaking with school personnel and developing a collaborative relationship with school staff can also be very helpful in changing a child’s behavior. Reach out to those who work with your child at school and share information about your concerns.

Here are some other tips for establishing relationships in your child's school or community:
Establish good communication with your child’s teachers and coaches at the start of the school year.Speak with school staff. Talk to the principal, dean, counselor, or social worker to determine if the school offers a bullying prevention program and how your child might be involved.Research ways for your child to be involved in groups that encourage cooperative relationships and focus on working with others.Seek help from your community. It’s important to find resources in both the school and community. Your child’s doctor, leaders of youth groups, coaches, or mental health practitioners can help you and your child learn how to understand and deal with bullying behavior.

博客

Read the article written by PACER staff, which was posted to Disney’s Babble blog:, What if Your Child Is the One Doing the Bullying?

浓缩版
When a child is bullying others, it’s important that parents and educators take action. It is equally important for adults to recognize that bullying is about behavior, and they should choose responses that acknowledge behavior can be changed. Reframing the focus from labeling a child as a “bully” to referring to them as a “child with bullying behavior” recognizes that there is capacity for change. While children who are bullying others should be given appropriate consequences for their behavior, adults should be talking with their children to learn why they are bullying others. Children need to understand the impact their behavior has on others and realize the hurt they are causing. With adult guidance, redirecting bullying behavior toward an understanding of differences, as well as the practices of kindness and inclusion, are good strategies for reshaping a child’s behavior.

完整版

Bullying is a learned behavior — and it can be “unlearned” and replaced with more positive behaviors. By talking with your child and taking action, you can teach your child more appropriate ways of handling feelings and responding to peer pressure and conflicts.

While it is important to look into any report of bullying and have it stopped quickly, it is good to remember that children are still developing an awareness of the skills they need to maintain healthy relationships. Their behavior can and does change throughout childhood as their identity is formed.

Finding strategies to assist with the development of positive behaviors can influence bullying behavior in children, at home, or at school. If you suspect or know that your child has been bullying others, here are some things to do right away and on an ongoing basis:

Talk with your child. Children may not always recognize their behavior as bullying. They may see it as “just having fun” and not realize the impact it has on another child. Help them understand what defines bullying and emphasize that this behavior is never appropriate.

Explore reasons for the behavior. Find out why your child is behaving in a manner that is harmful to others through an open, nonjudgmental discussion. Here are some helpful tips on having that conversation.

Confirm that your child’s behavior is bullying and not the result of a disability. Sometimes, children with disabilities who have certain emotional and behavioral disorders, or are in the process of developing social skills, may act in ways that are mistaken for bullying.

Develop an action plan. It’s important to think through the steps that work for you, your child, and your situation. A good tool to use is this Student Action Plan.

Teach empathy, respect, and compassion. Children who bully often lack awareness of how others feel or understand how their actions impact someone else. Try to understand your child’s feelings and help your child appreciate how others feel when they are bullied. Let your child know that everyone has feelings and that feelings matter.

Make your expectations clear. Let your child know that bullying is not okay under any circumstances and that you will not tolerate it. Let them know that there will be consequences for their behavior. Take immediate action if you learn that he or she is involved in a bullying incident.

Provide clear and consistent consequences for bullying. Be specific about what will happen if the bullying continues. Try to find meaningful consequences that fit the situation, such as loss of privileges or activities. If the behavior does not change, consider increasing the significance of the consequences.

Teach by example. Help your child learn different ways to resolve conflict and deal with feelings, such as anger, insecurity, or frustration. Teach and reward appropriate behavior.

Provide positive feedback. When your child handles conflict well, shows compassion for others, or find a positive way to deal with feelings, provide praise and recognition. Positive reinforcement can help improve behavior and is usually more effective than punishment.

Be realistic. It takes time to change behavior. Recognize that there may be setbacks. Be patient as your child learns new ways of handling feelings and conflict. Keep your concern and support visible.

Speaking with school personnel and developing a collaborative relationship with school staff can also be very helpful in changing a child’s behavior. Reach out to those who work with your child at school and share information about your concerns.

Here are some other tips for establishing relationships in your child's school or community:

Establish good communication with your child’s teachers and coaches at the start of the school year.

Speak with school staff. Talk to the principal, dean, counselor, or social worker to determine if the school offers a bullying prevention program and how your child might be involved.

Research ways for your child to be involved in groups that encourage cooperative relationships and focus on working with others.

Seek help from your community. It’s important to find resources in both the school and community. Your child’s doctor, leaders of youth groups, coaches, or mental health practitioners can help you and your child learn how to understand and deal with bullying behavior.

博客

Read the article written by PACER staff, which was posted to Disney’s Babble blog:, What if Your Child Is the One Doing the Bullying?

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PACER’s National Bullying Prevention Center uses the term “bullying prevention” instead of “anti-bullying” to place the emphasis on a proactive approach and philosophy, framing bullying as an issue to which there is a solution. While the use of “anti” does appropriately indicate the concept of being against bullying, the focus on “prevention” recognizes that change is ultimately about shifting behavior and attitudes, which can happen through the positive approach of education, awareness, and action.

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At PACER’s National Bullying Prevention Center, our vision is “to make every child safe and to change the culture in our society so that bullying is no longer viewed as acceptable behavior.” The language framing the goal is an important part of this change. It has the potential to influence the view of the issue and, in the best cases, direct ideas that promote positive behavior.

Using the term “bullying prevention” instead of “anti-bullying” places the focus where it should be: on understanding the actions that help prevent bullying from occurring. A term, such as “anti,” which focuses on the negative, often doesn’t allow for the opportunity to change or indicate what society can do about bullying.

Acting to change the behavior is vitally important to preventing bullying. Bullying should not be considered a childhood rite of passage. Instead, bullying behaviors should be viewed as changeable and preventable through education and awareness. Discussions with children that focus on inclusion over exclusion, and showing respect and kindness toward others need to occur frequently as children grow up. When children are brought to better awareness of these issues, they have a greater opportunity to develop empathy and an increased understanding that can ultimately disrupt or interrupt bullying dynamics.

In these ongoing conversations with children or throughout communities, to create a social environment where bullying is not accepted, include discussions on how bullying harms everyone involved — targets, witnesses, and the people who use these damaging behaviors. While “anti” does appropriately express being against bullying, the conversation must include preventative efforts. Discussing the steps necessary to resolve conflicts and promote healthy social interactions between people will lead to a culture focusing on a positive, proactive approach to preventing bullying.

浓缩版
PACER’s National Bullying Prevention Center uses the term “bullying prevention” instead of “anti-bullying” to place the emphasis on a proactive approach and philosophy, framing bullying as an issue to which there is a solution. While the use of “anti” does appropriately indicate the concept of being against bullying, the focus on “prevention” recognizes that change is ultimately about shifting behavior and attitudes, which can happen through the positive approach of education, awareness, and action.

完整版

At PACER’s National Bullying Prevention Center, our vision is “to make every child safe and to change the culture in our society so that bullying is no longer viewed as acceptable behavior.” The language framing the goal is an important part of this change. It has the potential to influence the view of the issue and, in the best cases, direct ideas that promote positive behavior.

Using the term “bullying prevention” instead of “anti-bullying” places the focus where it should be: on understanding the actions that help prevent bullying from occurring. A term, such as “anti,” which focuses on the negative, often doesn’t allow for the opportunity to change or indicate what society can do about bullying.

Acting to change the behavior is vitally important to preventing bullying. Bullying should not be considered a childhood rite of passage. Instead, bullying behaviors should be viewed as changeable and preventable through education and awareness. Discussions with children that focus on inclusion over exclusion, and showing respect and kindness toward others need to occur frequently as children grow up. When children are brought to better awareness of these issues, they have a greater opportunity to develop empathy and an increased understanding that can ultimately disrupt or interrupt bullying dynamics.

In these ongoing conversations with children or throughout communities, to create a social environment where bullying is not accepted, include discussions on how bullying harms everyone involved — targets, witnesses, and the people who use these damaging behaviors. While “anti” does appropriately express being against bullying, the conversation must include preventative efforts. Discussing the steps necessary to resolve conflicts and promote healthy social interactions between people will lead to a culture focusing on a positive, proactive approach to preventing bullying.

浓缩版
Friends will sometimes have bad days. Friends will sometimes disagree. Friends will sometimes hurt each other's feelings, have an argument, or simply need time away from one another. This is normal and can happen in any friendship, no matter how close. If you are experiencing treatment from a friend that hurts you and you have asked that friend to stop, but it still continues, then that is not friendship. That behavior could be bullying. Friendship behaviors do not include hurting someone on purpose or continually being mean even when asked to stop. A friend will change or be remorseful for her behavior if she finds out she's hurting you. If you aren't certain if what is happening is part of a normal friendship or if it is bullying, talk to an adult you trust and get help sorting out the relationship. And yes, it is okay (and the right thing to do) to ask for help.

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Is it possible that someone we call a friend, or even a best friend, is the very person that treats us the worst? How can the person with whom we share jokes, snacks, and secrets be someone who hurts us?

With relationships, it’s natural to have conflict as we learn how to be friends and communicate. Sometimes we make mistakes with friends, hurt their feelings, apologize for what we’ve done, and move on. Through making mistakes in our relationships, we learn what to do with the people around us — as well as what not to do. It’s normal to have conflicts or disagreements with friends as we grow up; that’s how we learn to be better friends and communicators.

What’s not okay — and is never deserved — is when someone we are close to decides to threaten us, to hurt our feelings intentionally, misuse our trust, or make us feel less than who we are. If someone we call a friend repeatedly uses bullying behavior — such as belittling who we are, trying to control us, or attempting to tell us who we can be friends with — that’s no longer a friend. That type of behavior is outside of friendship in every way and has to be called what it is: bullying.

This is a painful and sometimes unacknowledged type of bullying that is hard to understand and even harder to endure. Here’s how to recognize when those we are close to are bullying us, even though we call them “friends.”

Below are some examples to help recognize if bullying is happening in your relationships:
You are made fun of, called names, or teased for your appearance or what you wearYou are mocked or mimicked for what you say or how you actYou are laughed at when people know you’re hurting from being teased or physically abusedYou are told who you can be friends with or what you can and can’t doYou are purposefully excluded from events or get-togethers in which other friends are invitedYou have told your friends to stop the negative behavior and they continue anywayYou are made to feel that you don’t live up to the standards of the friend group

If you or someone you care about is being bullied by a “friend,” please find an adult you trust and tell them what’s going on as soon as possible. Bullying like this often does not stop without intervention. Bullying like this doesn’t go away if you ignore it either. This type of situation will need assistance and advice on making a plan for what to do.

You’ll also need allies, people around you at school or in your neighborhood who will actively support you and have your back. An ally will stand up for you if she feels safe, or be a witness to what’s going on and be able to tell an adult what she saw happen. An ally can help you feel less alone, too, which is a very good thing.

Don’t hesitate for too long when someone you call a friend is repeatedly disrespectful to you and causes you pain when you’ve asked them to stop. If you find you’re always nervous and anxious around a friend because you’re worried about what they might say or do to you, talk to an adult and work out what’s happening. Sometimes it will be a normal consequence of learning to be friends, and sometimes it will be bullying. If it’s bullying, that’s not friendship and it probably never will be. You have the right to be around people who treat you like a friend, and that you can respect and trust.

Teen Perspective

The following is excerpted from a response to a question submitted for the ASK JAMIE column on PACERTeensAgainstBullying.com.

The question came from Scarlett, a 7th grader, who wrote, “I love my friends, but sometimes I feel like they don’t like me much. At school they call me names all the time, then they say they are just joking, but it feels mean and sometimes I feel excluded and sad.”

Ask Jamie’s response: It sounds like you have been facing bullying from your friends but feel unsure of how to handle it, especially since it is veiled as “just a joke.” This is something I, and many others, relate to. It is difficult to know how to respond to a friend who says hurtful comments, since oftentimes they will defend themselves with the “joke” cover.

A general guideline is: If you don’t find it funny but do find it hurtful, then it isn’t okay.

Your friend may very well have intended the comment as a joke, but it is the way it makes you feel that matters. If you feel hurt, unsafe, or targeted by the joke, then ask your friends to stop. If it happens again, and as long as you stay safe, say something like: “I know you probably think that you are just kidding, but the comments you have made are really hurtful, so I would really appreciate if you would stop. I know that if you realized how much your words affected me, you would stop.”

If they cannot respect your requests, then they are not being true friends and, therefore, may not deserve your friendship. Realize that you deserved to be treated with kindness, so any friendships that are offering meanness should be evaluated and its your decision about whether or not to continue the relationship.

浓缩版
Friends will sometimes have bad days. Friends will sometimes disagree. Friends will sometimes hurt each other's feelings, have an argument, or simply need time away from one another. This is normal and can happen in any friendship, no matter how close. If you are experiencing treatment from a friend that hurts you and you have asked that friend to stop, but it still continues, then that is not friendship. That behavior could be bullying. Friendship behaviors do not include hurting someone on purpose or continually being mean even when asked to stop. A friend will change or be remorseful for her behavior if she finds out she's hurting you. If you aren't certain if what is happening is part of a normal friendship or if it is bullying, talk to an adult you trust and get help sorting out the relationship. And yes, it is okay (and the right thing to do) to ask for help.

完整版

Is it possible that someone we call a friend, or even a best friend, is the very person that treats us the worst? How can the person with whom we share jokes, snacks, and secrets be someone who hurts us?

With relationships, it’s natural to have conflict as we learn how to be friends and communicate. Sometimes we make mistakes with friends, hurt their feelings, apologize for what we’ve done, and move on. Through making mistakes in our relationships, we learn what to do with the people around us — as well as what not to do. It’s normal to have conflicts or disagreements with friends as we grow up; that’s how we learn to be better friends and communicators.

What’s not okay — and is never deserved — is when someone we are close to decides to threaten us, to hurt our feelings intentionally, misuse our trust, or make us feel less than who we are. If someone we call a friend repeatedly uses bullying behavior — such as belittling who we are, trying to control us, or attempting to tell us who we can be friends with — that’s no longer a friend. That type of behavior is outside of friendship in every way and has to be called what it is: bullying.

This is a painful and sometimes unacknowledged type of bullying that is hard to understand and even harder to endure. Here’s how to recognize when those we are close to are bullying us, even though we call them “friends.”

Below are some examples to help recognize if bullying is happening in your relationships:

You are made fun of, called names, or teased for your appearance or what you wear

You are mocked or mimicked for what you say or how you act

You are laughed at when people know you’re hurting from being teased or physically abused

You are told who you can be friends with or what you can and can’t do

You are purposefully excluded from events or get-togethers in which other friends are invited

You have told your friends to stop the negative behavior and they continue anyway

You are made to feel that you don’t live up to the standards of the friend group

If you or someone you care about is being bullied by a “friend,” please find an adult you trust and tell them what’s going on as soon as possible. Bullying like this often does not stop without intervention. Bullying like this doesn’t go away if you ignore it either. This type of situation will need assistance and advice on making a plan for what to do.

You’ll also need allies, people around you at school or in your neighborhood who will actively support you and have your back. An ally will stand up for you if she feels safe, or be a witness to what’s going on and be able to tell an adult what she saw happen. An ally can help you feel less alone, too, which is a very good thing.

Don’t hesitate for too long when someone you call a friend is repeatedly disrespectful to you and causes you pain when you’ve asked them to stop. If you find you’re always nervous and anxious around a friend because you’re worried about what they might say or do to you, talk to an adult and work out what’s happening. Sometimes it will be a normal consequence of learning to be friends, and sometimes it will be bullying. If it’s bullying, that’s not friendship and it probably never will be. You have the right to be around people who treat you like a friend, and that you can respect and trust.

Teen Perspective

The following is excerpted from a response to a question submitted for the ASK JAMIE column on PACERTeensAgainstBullying.com.

The question came from Scarlett, a 7th grader, who wrote, “I love my friends, but sometimes I feel like they don’t like me much. At school they call me names all the time, then they say they are just joking, but it feels mean and sometimes I feel excluded and sad.”

Ask Jamie’s response: It sounds like you have been facing bullying from your friends but feel unsure of how to handle it, especially since it is veiled as “just a joke.” This is something I, and many others, relate to. It is difficult to know how to respond to a friend who says hurtful comments, since oftentimes they will defend themselves with the “joke” cover.

A general guideline is: If you don’t find it funny but do find it hurtful, then it isn’t okay.

Your friend may very well have intended the comment as a joke, but it is the way it makes you feel that matters. If you feel hurt, unsafe, or targeted by the joke, then ask your friends to stop. If it happens again, and as long as you stay safe, say something like: “I know you probably think that you are just kidding, but the comments you have made are really hurtful, so I would really appreciate if you would stop. I know that if you realized how much your words affected me, you would stop.”

If they cannot respect your requests, then they are not being true friends and, therefore, may not deserve your friendship. Realize that you deserved to be treated with kindness, so any friendships that are offering meanness should be evaluated and its your decision about whether or not to continue the relationship.

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Bullying and harassment are often used interchangeably when talking about hurtful or harmful behavior. They are very similar, but in terms of definition, there is an important difference.

Bullying and harassment are similar as they are both about:
power and controlactions that hurt or harm another person physically or emotionallyan imbalance of power between the target and the individual demonstrating the negative behaviorthe target having difficulty stopping the action directed at them

The distinction between bullying and harassment is that when the bullying behavior directed at the target is also based on a protected class, that behavior is then defined as harassment. Protected classes include:
racecolorreligionsexagedisabilitynational origin

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Although bullying and harassment are often used interchangeably when talking about hurtful or harmful behavior — and the behavior may look the same — there are important distinctions in the definition, laws, and protections for students experiencing harassment.

The first difference is in the definitions of bullying and harassment. For bullying, it’s important to note that while definitions vary from source to source, most agree that an act is defined as bullying when the behavior hurts, harms, or humiliates another person physically or emotionally. Those targeted by bullying behavior struggle to defend themselves and stop the action directed at them. There also is an “imbalance of power.” This means the student demonstrating the bullying behavior has more power; this can be physically, socially, or emotionally (for example, a higher social status, physically larger, or emotionally intimidating).

The definition of harassment outlines that the behavior is similar by its unwanted and hurtful actions. It can include unwelcome conduct such as verbal abuse, graphic or written statements, threats, physical assault, or other conduct that is threatening or humiliating, but the negative behavior is based on a student’s race, color, religion, sex, age, disability, or national origin. For example, bullying behavior meets the threshold of harassment when a student is being verbally bullied with demeaning language about their disability.

Students experiencing harassment also have protections at the federal level. The Office of Civil Rights (OCR) and the Department of Justice (DOJ) have stated that bullying is considered discriminatory harassment when based on a student’s race, color, religion, sex, age, disability, or national origin. If a student is experiencing discriminatory harassment, federally funded schools are obligated under federal law to address the behavior.

If you’re looking for more information on how schools are required to address the behavior, visit stopbullying.gov.

浓缩版
Bullying and harassment are often used interchangeably when talking about hurtful or harmful behavior. They are very similar, but in terms of definition, there is an important difference.

Bullying and harassment are similar as they are both about:

power and control

actions that hurt or harm another person physically or emotionally

an imbalance of power between the target and the individual demonstrating the negative behavior

the target having difficulty stopping the action directed at them

The distinction between bullying and harassment is that when the bullying behavior directed at the target is also based on a protected class, that behavior is then defined as harassment. Protected classes include:

race

color

religion

sex

age

disability

national origin

完整版

Although bullying and harassment are often used interchangeably when talking about hurtful or harmful behavior — and the behavior may look the same — there are important distinctions in the definition, laws, and protections for students experiencing harassment.

The first difference is in the definitions of bullying and harassment. For bullying, it’s important to note that while definitions vary from source to source, most agree that an act is defined as bullying when the behavior hurts, harms, or humiliates another person physically or emotionally. Those targeted by bullying behavior struggle to defend themselves and stop the action directed at them. There also is an “imbalance of power.” This means the student demonstrating the bullying behavior has more power; this can be physically, socially, or emotionally (for example, a higher social status, physically larger, or emotionally intimidating).

The definition of harassment outlines that the behavior is similar by its unwanted and hurtful actions. It can include unwelcome conduct such as verbal abuse, graphic or written statements, threats, physical assault, or other conduct that is threatening or humiliating, but the negative behavior is based on a student’s race, color, religion, sex, age, disability, or national origin. For example, bullying behavior meets the threshold of harassment when a student is being verbally bullied with demeaning language about their disability.

Students experiencing harassment also have protections at the federal level. The Office of Civil Rights (OCR) and the Department of Justice (DOJ) have stated that bullying is considered discriminatory harassment when based on a student’s race, color, religion, sex, age, disability, or national origin. If a student is experiencing discriminatory harassment, federally funded schools are obligated under federal law to address the behavior.

If you’re looking for more information on how schools are required to address the behavior, visit stopbullying.gov.